| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,423 |
2,270 |
$168K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,605 |
1,517 |
$163K |
| D0330 |
Panoramic radiographic image |
50 |
48 |
$4K |
| 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 |
205 |
185 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
73 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
44 |
44 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
14 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$914.71 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$772.80 |
| 81025 |
|
50 |
42 |
$551.44 |