| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,787 |
2,816 |
$82K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,528 |
1,153 |
$47K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
109 |
94 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
267 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
88 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
58 |
25 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
713 |
543 |
$2K |
| D1206 |
Topical application of fluoride varnish |
192 |
181 |
$1K |
| 90677 |
|
14 |
14 |
$1K |
| 81025 |
|
690 |
510 |
$1K |
| H1000 |
Prenatal care, at-risk assessment |
18 |
18 |
$786.62 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
38 |
38 |
$742.52 |
| D1330 |
|
210 |
200 |
$731.65 |
| 1159F |
|
3,759 |
3,129 |
$707.89 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
143 |
124 |
$568.84 |
| 81002 |
|
952 |
712 |
$540.20 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
28 |
$532.00 |
| D0274 |
Bitewings - four radiographic images |
110 |
96 |
$498.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
30 |
$480.00 |
| 99401 |
|
48 |
44 |
$473.84 |
| D1110 |
Prophylaxis - adult |
58 |
58 |
$472.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
38 |
12 |
$303.84 |
| 82962 |
|
357 |
309 |
$296.93 |
| D0120 |
Periodic oral evaluation - established patient |
56 |
42 |
$258.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
12 |
$251.00 |
| 90686 |
|
82 |
68 |
$250.17 |
| 82947 |
|
417 |
214 |
$203.28 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
38 |
$191.68 |
| 86703 |
|
170 |
64 |
$186.84 |
| 3044F |
|
662 |
549 |
$180.72 |
| 36415 |
Collection of venous blood by venipuncture |
227 |
201 |
$165.00 |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
139 |
$150.50 |
| D1120 |
Prophylaxis - child |
16 |
14 |
$131.00 |
| 99406 |
|
16 |
12 |
$33.50 |
| 3075F |
|
1,423 |
961 |
$25.00 |
| 1000F |
|
6,653 |
4,686 |
$24.96 |
| D0191 |
|
63 |
63 |
$20.90 |
| D0603 |
|
119 |
101 |
$10.00 |
| 92551 |
|
228 |
96 |
$4.89 |
| 3351F |
|
1,894 |
839 |
$0.04 |
| 3078F |
|
3,708 |
2,543 |
$0.03 |
| 2001F |
|
5,053 |
4,053 |
$0.00 |
| 1220F |
|
2,768 |
2,447 |
$0.00 |
| 2000F |
|
4,837 |
3,864 |
$0.00 |
| 3008F |
|
7,034 |
4,853 |
$0.00 |
| 3074F |
|
4,275 |
3,174 |
$0.00 |
| 1126F |
|
2,261 |
1,957 |
$0.00 |
| 3079F |
|
2,505 |
1,719 |
$0.00 |
| 0513F |
|
739 |
193 |
$0.00 |
| 96127 |
|
24 |
24 |
$0.00 |
| 1036F |
|
668 |
465 |
$0.00 |
| 4000F |
|
315 |
269 |
$0.00 |
| 1125F |
|
552 |
486 |
$0.00 |
| 36416 |
|
305 |
258 |
$0.00 |
| 4037F |
|
39 |
25 |
$0.00 |
| 4010F |
|
77 |
49 |
$0.00 |
| 3048F |
|
24 |
17 |
$0.00 |
| 1034F |
|
91 |
68 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
13 |
$0.00 |
| 3049F |
|
14 |
13 |
$0.00 |
| D1310 |
|
16 |
16 |
$0.00 |
| 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 |
20 |
12 |
$0.00 |
| 1030F |
|
74 |
52 |
$0.00 |
| 1160F |
|
3,795 |
3,157 |
$0.00 |
| 3077F |
|
76 |
56 |
$0.00 |
| 99173 |
|
230 |
96 |
$0.00 |
| 1033F |
|
32 |
31 |
$0.00 |
| 4004F |
|
160 |
79 |
$0.00 |
| 1158F |
|
13 |
13 |
$0.00 |
| 4035F |
|
70 |
48 |
$0.00 |