| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
536 |
313 |
$14K |
| D1110 |
Prophylaxis - adult |
266 |
258 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
48 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
118 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
115 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
148 |
146 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
52 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
69 |
39 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
69 |
68 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
134 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$1K |
| 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 |
1,025 |
550 |
$134.18 |
| 90674 |
|
13 |
13 |
$120.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$84.00 |