| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,439 |
1,623 |
$157K |
| D1110 |
Prophylaxis - adult |
1,072 |
693 |
$68K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
753 |
457 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
761 |
503 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
190 |
$14K |
| D1120 |
Prophylaxis - child |
245 |
132 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
102 |
$7K |
| D0274 |
Bitewings - four radiographic images |
99 |
94 |
$3K |
| D1206 |
Topical application of fluoride varnish |
111 |
111 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
15 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| 96127 |
|
43 |
14 |
$770.42 |
| 0012A |
|
19 |
19 |
$736.78 |
| 36415 |
Collection of venous blood by venipuncture |
136 |
112 |
$673.75 |
| 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 |
23 |
12 |
$627.24 |
| 90686 |
|
22 |
13 |
$352.40 |
| 0011A |
|
20 |
20 |
$341.34 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
16 |
$310.76 |
| 92551 |
|
12 |
12 |
$59.62 |
| D1999 |
|
33 |
29 |
$0.00 |