| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,580 |
1,411 |
$53K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
286 |
254 |
$12K |
| 99385 |
|
67 |
65 |
$8K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
46 |
42 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
50 |
50 |
$1K |
| 3074F |
|
1,643 |
1,473 |
$925.00 |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$518.81 |
| D1110 |
Prophylaxis - adult |
56 |
56 |
$505.19 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$322.21 |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
98 |
$237.43 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
35 |
35 |
$228.96 |
| D1330 |
|
152 |
150 |
$189.63 |
| 3078F |
|
1,491 |
1,255 |
$125.17 |
| D1320 |
|
27 |
27 |
$74.13 |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
55 |
$39.93 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
30 |
29 |
$30.83 |
| D1120 |
Prophylaxis - child |
32 |
32 |
$28.26 |
| 3079F |
|
172 |
147 |
$25.00 |
| D0180 |
|
12 |
12 |
$20.92 |
| 3008F |
|
2,411 |
2,014 |
$13.07 |
| 3044F |
|
242 |
229 |
$13.07 |
| 1159F |
|
1,062 |
955 |
$13.07 |
| 81025 |
|
15 |
15 |
$5.26 |
| 36415 |
Collection of venous blood by venipuncture |
64 |
62 |
$5.00 |
| 2000F |
|
2,377 |
1,981 |
$0.00 |
| 1000F |
|
1,980 |
1,723 |
$0.00 |
| 1125F |
|
58 |
51 |
$0.00 |
| 1220F |
|
2,140 |
1,918 |
$0.00 |
| 2001F |
|
2,560 |
2,148 |
$0.00 |
| 1126F |
|
1,274 |
1,136 |
$0.00 |
| 1157F |
|
57 |
42 |
$0.00 |
| 4000F |
|
50 |
44 |
$0.00 |
| 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 |
33 |
24 |
$0.00 |
| 2010F |
|
85 |
80 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
61 |
$0.00 |
| 94760 |
|
27 |
26 |
$0.00 |
| 3075F |
|
27 |
25 |
$0.00 |
| 81001 |
|
14 |
14 |
$0.00 |
| 1160F |
|
1,079 |
968 |
$0.00 |
| 1033F |
|
89 |
84 |
$0.00 |
| 1018F |
|
25 |
25 |
$0.00 |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$0.00 |