| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
70 |
68 |
$4K |
| 90837 |
Psychotherapy, 53 minutes with patient |
31 |
23 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
92 |
89 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
91 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
37 |
36 |
$2K |
| D1120 |
Prophylaxis - child |
47 |
47 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
24 |
18 |
$1K |
| D0274 |
Bitewings - four radiographic images |
46 |
45 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
14 |
14 |
$784.31 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
20 |
$649.55 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$294.75 |
| 99406 |
|
32 |
30 |
$248.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$206.43 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$119.80 |
| 90686 |
|
12 |
12 |
$93.88 |
| 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 |
22 |
19 |
$76.85 |
| 96127 |
|
12 |
12 |
$37.13 |
| 1000F |
|
100 |
93 |
$0.00 |
| 3074F |
|
81 |
80 |
$0.00 |
| 3079F |
|
68 |
67 |
$0.00 |
| G9459 |
Currently a tobacco non-user |
39 |
35 |
$0.00 |
| 3075F |
|
31 |
30 |
$0.00 |
| 3078F |
|
45 |
44 |
$0.00 |