| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,765 |
4,014 |
$733K |
| D1206 |
Topical application of fluoride varnish |
1,300 |
1,233 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
952 |
802 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
766 |
665 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
986 |
938 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
209 |
99 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
284 |
280 |
$7K |
| D4910 |
|
344 |
336 |
$6K |
| D0274 |
Bitewings - four radiographic images |
250 |
244 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
133 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
59 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
532 |
431 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
49 |
$1K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
69 |
39 |
$970.34 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
25 |
$935.34 |
| 0012A |
|
31 |
31 |
$794.92 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
65 |
56 |
$713.08 |
| 0071A |
|
17 |
16 |
$640.00 |
| 0072A |
|
15 |
13 |
$520.00 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$490.68 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$399.38 |
| D4342 |
|
45 |
29 |
$388.60 |
| D1120 |
Prophylaxis - child |
14 |
12 |
$376.20 |
| 96127 |
|
43 |
40 |
$324.90 |
| 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 |
1,771 |
1,333 |
$318.54 |
| 0011A |
|
19 |
19 |
$287.98 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
35 |
18 |
$250.09 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$47.35 |
| D0603 |
|
132 |
125 |
$0.00 |
| D1351 |
Sealant - per tooth |
76 |
12 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
74 |
44 |
$0.00 |
| 91301 |
|
63 |
62 |
$0.00 |
| 91307 |
|
39 |
35 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
17 |
14 |
$0.00 |
| D0180 |
|
36 |
36 |
$0.00 |