| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,360 |
1,153 |
$69K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
422 |
359 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
214 |
214 |
$4K |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$3K |
| 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 |
199 |
153 |
$3K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$1K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
37 |
32 |
$1K |
| 87428 |
|
29 |
28 |
$966.47 |
| 99000 |
|
583 |
496 |
$851.54 |
| 90686 |
|
65 |
56 |
$631.07 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
16 |
$504.93 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$435.76 |
| 36415 |
Collection of venous blood by venipuncture |
203 |
186 |
$418.29 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
27 |
27 |
$362.33 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$303.60 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
98 |
87 |
$238.34 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$0.00 |