| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,802 |
2,268 |
$121K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,515 |
1,871 |
$76K |
| D1120 |
Prophylaxis - child |
500 |
479 |
$19K |
| D1206 |
Topical application of fluoride varnish |
999 |
959 |
$18K |
| D1110 |
Prophylaxis - adult |
508 |
474 |
$15K |
| D0330 |
Panoramic radiographic image |
478 |
462 |
$14K |
| D1354 |
|
1,476 |
267 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
144 |
138 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
706 |
672 |
$7K |
| D1351 |
Sealant - per tooth |
456 |
128 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
100 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
585 |
505 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
74 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
96 |
$3K |
| D0191 |
|
867 |
843 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
460 |
382 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
55 |
48 |
$567.81 |
| D0274 |
Bitewings - four radiographic images |
104 |
102 |
$514.22 |
| D0602 |
|
2,653 |
2,312 |
$383.37 |
| D1330 |
|
1,205 |
1,144 |
$378.80 |
| 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 |
480 |
326 |
$358.14 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
66 |
64 |
$295.94 |
| D0220 |
Intraoral - periapical first radiographic image |
363 |
337 |
$270.15 |
| D0603 |
|
612 |
575 |
$255.45 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
31 |
30 |
$189.07 |
| 81003 |
|
475 |
359 |
$178.26 |
| 81025 |
|
154 |
113 |
$150.02 |
| D1355 |
|
199 |
53 |
$114.03 |
| 1159F |
|
589 |
473 |
$101.41 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30 |
28 |
$20.68 |
| 36415 |
Collection of venous blood by venipuncture |
440 |
384 |
$0.00 |
| 3008F |
|
1,143 |
914 |
$0.00 |
| 3074F |
|
577 |
427 |
$0.00 |
| 1036F |
|
407 |
322 |
$0.00 |
| 1034F |
|
97 |
83 |
$0.00 |
| 1111F |
|
87 |
75 |
$0.00 |
| 90686 |
|
29 |
26 |
$0.00 |
| 3079F |
|
159 |
120 |
$0.00 |
| 1126F |
|
140 |
106 |
$0.00 |
| 3075F |
|
20 |
13 |
$0.00 |
| 1125F |
|
53 |
45 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
15 |
13 |
$0.00 |
| 3725F |
|
1,453 |
1,153 |
$0.00 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
80 |
71 |
$0.00 |
| 3078F |
|
493 |
354 |
$0.00 |
| 1160F |
|
211 |
170 |
$0.00 |
| 3077F |
|
27 |
26 |
$0.00 |