| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
862 |
751 |
$35K |
| D1120 |
Prophylaxis - child |
1,054 |
1,052 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
552 |
509 |
$25K |
| D0330 |
Panoramic radiographic image |
265 |
265 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,281 |
1,277 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
737 |
737 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,740 |
987 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
338 |
$8K |
| 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 |
510 |
392 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
163 |
141 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
55 |
$4K |
| D1110 |
Prophylaxis - adult |
85 |
85 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,111 |
1,097 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
46 |
46 |
$3K |
| D1330 |
|
1,237 |
1,234 |
$3K |
| D0274 |
Bitewings - four radiographic images |
343 |
342 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
76 |
76 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
418 |
416 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$495.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$165.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
14 |
$40.00 |
| 3074F |
|
725 |
683 |
$25.00 |
| 36415 |
Collection of venous blood by venipuncture |
187 |
182 |
$0.66 |
| 1159F |
|
359 |
350 |
$0.00 |
| 3078F |
|
578 |
556 |
$0.00 |
| 1160F |
|
360 |
351 |
$0.00 |
| 3077F |
|
34 |
33 |
$0.00 |
| 1126F |
|
412 |
397 |
$0.00 |
| 1000F |
|
1,094 |
1,019 |
$0.00 |
| 1220F |
|
772 |
727 |
$0.00 |
| 2001F |
|
1,138 |
1,053 |
$0.00 |
| 2000F |
|
1,172 |
1,077 |
$0.00 |
| 3008F |
|
1,164 |
1,077 |
$0.00 |
| 3079F |
|
295 |
283 |
$0.00 |
| 3044F |
|
124 |
119 |
$0.00 |
| 3075F |
|
107 |
106 |
$0.00 |
| 1125F |
|
41 |
40 |
$0.00 |
| 4000F |
|
169 |
165 |
$0.00 |