| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
28,736 |
26,089 |
$5.63M |
| D7140 |
Extraction, erupted tooth or exposed root |
1,371 |
616 |
$92K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,526 |
10,823 |
$91K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,536 |
2,456 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
252 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
518 |
506 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
121 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
579 |
568 |
$9K |
| 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 |
211 |
190 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
29 |
29 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
29 |
$5K |
| 99441 |
|
57 |
57 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
26 |
$958.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
112 |
96 |
$932.04 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
62 |
62 |
$629.58 |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
13 |
13 |
$545.70 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
43 |
43 |
$421.82 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
14 |
$220.50 |
| 96127 |
|
13 |
13 |
$43.08 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
309 |
309 |
$21.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
29 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
699 |
699 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
137 |
137 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
14 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
323 |
323 |
$0.00 |
| D1120 |
Prophylaxis - child |
138 |
138 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |