| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
11,476 |
9,883 |
$503K |
| 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 |
1,389 |
1,201 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
283 |
280 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,538 |
1,268 |
$0.00 |
| 91301 |
|
37 |
35 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,814 |
2,447 |
$0.00 |
| D1330 |
|
87 |
87 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
642 |
572 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
984 |
733 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,281 |
1,091 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
272 |
198 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
744 |
554 |
$0.00 |
| 0012A |
|
27 |
26 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
363 |
234 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
450 |
374 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
51 |
46 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
14 |
$0.00 |
| D1351 |
Sealant - per tooth |
171 |
39 |
$0.00 |
| 92551 |
|
27 |
27 |
$0.00 |
| D0240 |
|
18 |
13 |
$0.00 |
| D0603 |
|
47 |
47 |
$0.00 |
| 90686 |
|
30 |
30 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$0.00 |
| 36416 |
|
136 |
112 |
$0.00 |
| 0011A |
|
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,383 |
1,142 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,932 |
1,594 |
$0.00 |
| D0190 |
|
1,665 |
1,659 |
$0.00 |
| D1110 |
Prophylaxis - adult |
808 |
641 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,187 |
928 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
330 |
210 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
209 |
197 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
69 |
66 |
$0.00 |
| 99173 |
|
18 |
18 |
$0.00 |
| 90662 |
|
14 |
12 |
$0.00 |