| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
645 |
583 |
$77K |
| D0999 |
Unspecified diagnostic procedure, by report |
319 |
311 |
$31K |
| D1206 |
Topical application of fluoride varnish |
203 |
203 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
91 |
85 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
70 |
69 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
30 |
$4K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
14 |
$2K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
41 |
33 |
$108.12 |
| 90686 |
|
35 |
34 |
$19.03 |
| D1351 |
Sealant - per tooth |
47 |
13 |
$0.00 |
| 90461 |
|
31 |
31 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |