| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,251 |
2,041 |
$156K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,473 |
845 |
$102K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
695 |
642 |
$66K |
| D1110 |
Prophylaxis - adult |
44 |
39 |
$3K |
| 86703 |
|
54 |
51 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
37 |
37 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
32 |
$757.00 |
| D0330 |
Panoramic radiographic image |
20 |
16 |
$734.16 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
16 |
$531.56 |
| 90832 |
Psychotherapy, 30 minutes with patient |
18 |
12 |
$462.64 |
| D0274 |
Bitewings - four radiographic images |
17 |
14 |
$430.56 |
| 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 |
12 |
12 |
$367.29 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
13 |
$318.20 |