| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,990 |
558 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
1,654 |
1,463 |
$43K |
| D0274 |
Bitewings - four radiographic images |
626 |
567 |
$37K |
| D0330 |
Panoramic radiographic image |
357 |
309 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
197 |
52 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
175 |
150 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
94 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
114 |
109 |
$7K |
| 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 |
163 |
162 |
$4K |
| D1110 |
Prophylaxis - adult |
38 |
37 |
$3K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
136 |
104 |
$3K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
76 |
56 |
$2K |
| D0270 |
|
13 |
12 |
$288.48 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
20 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
67 |
67 |
$0.00 |