| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,729 |
2,229 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
125 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
104 |
95 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
304 |
207 |
$5K |
| D0330 |
Panoramic radiographic image |
233 |
232 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
369 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
88 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
326 |
200 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
37 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
99 |
$900.34 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$828.17 |
| D0120 |
Periodic oral evaluation - established patient |
79 |
54 |
$813.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
16 |
12 |
$750.17 |
| D0220 |
Intraoral - periapical first radiographic image |
469 |
427 |
$630.09 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
128 |
25 |
$505.04 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$252.00 |
| 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 |
389 |
266 |
$205.02 |
| D1330 |
|
54 |
50 |
$84.93 |
| 1160F |
|
3,378 |
2,584 |
$49.60 |
| 1159F |
|
3,353 |
2,562 |
$37.45 |
| D0603 |
|
313 |
292 |
$17.00 |
| 81003 |
|
220 |
172 |
$10.33 |
| D0190 |
|
47 |
41 |
$10.00 |
| 81025 |
|
104 |
95 |
$8.74 |
| 1036F |
|
556 |
488 |
$4.62 |
| 82962 |
|
1,005 |
513 |
$4.38 |
| 3078F |
|
285 |
192 |
$0.00 |
| 4035F |
|
32 |
30 |
$0.00 |
| 4013F |
|
71 |
64 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
19 |
13 |
$0.00 |
| 99173 |
|
37 |
36 |
$0.00 |
| 3077F |
|
53 |
30 |
$0.00 |
| 2001F |
|
1,766 |
1,492 |
$0.00 |
| 2010F |
|
3,183 |
2,443 |
$0.00 |
| 2000F |
|
1,427 |
1,179 |
$0.00 |
| 1220F |
|
705 |
598 |
$0.00 |
| 3008F |
|
1,567 |
1,006 |
$0.00 |
| 1000F |
|
575 |
516 |
$0.00 |
| 4000F |
|
44 |
39 |
$0.00 |
| 3074F |
|
298 |
215 |
$0.00 |
| 4010F |
|
149 |
91 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
120 |
79 |
$0.00 |
| 3079F |
|
269 |
191 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
98 |
55 |
$0.00 |
| 1034F |
|
62 |
56 |
$0.00 |
| 1055F |
|
37 |
36 |
$0.00 |
| 3351F |
|
55 |
54 |
$0.00 |
| 3075F |
|
47 |
28 |
$0.00 |
| 87428 |
|
13 |
12 |
$0.00 |
| 1125F |
|
31 |
31 |
$0.00 |