| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,948 |
6,767 |
$1.52M |
| 99199 |
Unlisted special service, procedure or report |
33,553 |
15,623 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
3,575 |
3,320 |
$87K |
| D1110 |
Prophylaxis - adult |
1,776 |
1,676 |
$64K |
| D1120 |
Prophylaxis - child |
2,248 |
2,107 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,424 |
3,167 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
613 |
557 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
574 |
537 |
$19K |
| 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 |
997 |
829 |
$19K |
| D0274 |
Bitewings - four radiographic images |
554 |
527 |
$16K |
| 80305 |
|
1,178 |
757 |
$14K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
1,493 |
1,358 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
109 |
$13K |
| D0272 |
Bitewings - two radiographic images |
543 |
508 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
60 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
484 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
38 |
$6K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
102 |
68 |
$3K |
| D1206 |
Topical application of fluoride varnish |
101 |
94 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
61 |
43 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,006 |
824 |
$633.17 |
| 0011A |
|
19 |
19 |
$472.46 |
| 96127 |
|
69 |
60 |
$78.01 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
44 |
34 |
$42.51 |
| 3074F |
|
529 |
449 |
$0.75 |
| 3079F |
|
249 |
224 |
$0.47 |
| 3078F |
|
382 |
321 |
$0.45 |
| 3077F |
|
46 |
40 |
$0.05 |
| 3075F |
|
31 |
26 |
$0.04 |
| 3080F |
|
29 |
27 |
$0.02 |
| D0603 |
|
200 |
194 |
$0.00 |
| 91301 |
|
26 |
24 |
$0.00 |
| D0602 |
|
29 |
28 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
15 |
12 |
$0.00 |
| D1330 |
|
14 |
13 |
$0.00 |