| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
990 |
975 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,539 |
1,483 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
879 |
863 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
380 |
373 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
581 |
433 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,386 |
1,297 |
$0.00 |
| 90656 |
|
27 |
27 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
176 |
175 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,422 |
1,911 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
653 |
260 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
835 |
814 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,727 |
8,199 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,183 |
8,725 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
125 |
$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 |
2,851 |
2,045 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
70 |
65 |
$0.00 |
| 87430 |
|
25 |
25 |
$0.00 |
| 99385 |
|
14 |
13 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
28 |
25 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
55 |
55 |
$0.00 |
| 36416 |
|
83 |
81 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
90 |
82 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$0.00 |
| 99443 |
|
14 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
16 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
974 |
941 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,786 |
1,752 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
4,989 |
1,414 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,283 |
1,263 |
$0.00 |
| D4910 |
|
426 |
411 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
334 |
212 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,079 |
1,042 |
$0.00 |
| D0270 |
|
237 |
234 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
675 |
631 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
931 |
806 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
936 |
885 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,848 |
2,706 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
7,017 |
3,392 |
$0.00 |
| 90785 |
|
311 |
111 |
$0.00 |
| 80305 |
|
267 |
255 |
$0.00 |
| D0330 |
Panoramic radiographic image |
406 |
402 |
$0.00 |
| 81025 |
|
61 |
55 |
$0.00 |
| 99442 |
|
27 |
27 |
$0.00 |
| D4341 |
|
27 |
12 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
61 |
56 |
$0.00 |
| 87400 |
|
55 |
51 |
$0.00 |
| 81003 |
|
205 |
188 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
17 |
14 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
17 |
16 |
$0.00 |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
83 |
49 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14 |
14 |
$0.00 |