| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,791 |
1,620 |
$118K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
703 |
593 |
$51K |
| 96156 |
|
256 |
241 |
$17K |
| 96158 |
|
287 |
231 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
111 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
323 |
$5K |
| D1206 |
Topical application of fluoride varnish |
232 |
231 |
$5K |
| 99443 |
|
52 |
49 |
$4K |
| D1120 |
Prophylaxis - child |
92 |
92 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
104 |
104 |
$4K |
| 99442 |
|
51 |
48 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
74 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
360 |
161 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
27 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
19 |
16 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
24 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$2K |
| 98967 |
|
28 |
24 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
35 |
30 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$983.32 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$857.14 |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$842.40 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
101 |
95 |
$501.02 |
| 36415 |
Collection of venous blood by venipuncture |
244 |
218 |
$402.83 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
57 |
54 |
$355.56 |
| D0270 |
|
28 |
27 |
$234.00 |
| 96160 |
|
27 |
25 |
$74.29 |
| 36416 |
|
27 |
27 |
$26.91 |
| 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 |
127 |
96 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
36 |
14 |
$0.00 |