| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,399 |
1,234 |
$51K |
| D1110 |
Prophylaxis - adult |
648 |
642 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
748 |
734 |
$18K |
| D1120 |
Prophylaxis - child |
473 |
461 |
$14K |
| D0330 |
Panoramic radiographic image |
706 |
693 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,055 |
1,028 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
1,022 |
907 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,091 |
1,004 |
$9K |
| 99385 |
|
83 |
70 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
139 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
147 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
74 |
63 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
111 |
85 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
72 |
71 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
74 |
60 |
$4K |
| D1330 |
|
3,060 |
2,903 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,556 |
1,460 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
500 |
$1K |
| 3074F |
|
1,286 |
1,115 |
$925.00 |
| D0274 |
Bitewings - four radiographic images |
306 |
299 |
$789.51 |
| D0140 |
Limited oral evaluation - problem focused |
110 |
109 |
$782.47 |
| 1000F |
|
1,540 |
1,290 |
$368.23 |
| 36415 |
Collection of venous blood by venipuncture |
238 |
205 |
$104.61 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
113 |
90 |
$91.76 |
| 1159F |
|
1,285 |
1,110 |
$75.66 |
| 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 |
45 |
34 |
$26.38 |
| 1126F |
|
914 |
794 |
$20.95 |
| 81002 |
|
26 |
14 |
$17.87 |
| 82962 |
|
13 |
12 |
$4.80 |
| 1033F |
|
97 |
93 |
$0.01 |
| 3078F |
|
1,194 |
982 |
$0.00 |
| 1160F |
|
1,283 |
1,109 |
$0.00 |
| D0180 |
|
12 |
12 |
$0.00 |
| 2000F |
|
1,731 |
1,416 |
$0.00 |
| 2001F |
|
1,894 |
1,568 |
$0.00 |
| 1220F |
|
1,593 |
1,418 |
$0.00 |
| 3008F |
|
1,710 |
1,397 |
$0.00 |
| 3044F |
|
183 |
162 |
$0.00 |
| 2010F |
|
44 |
42 |
$0.00 |
| 1157F |
|
27 |
16 |
$0.00 |