| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
375 |
194 |
$24K |
| 90837 |
Psychotherapy, 53 minutes with patient |
167 |
75 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
375 |
315 |
$13K |
| D1206 |
Topical application of fluoride varnish |
791 |
613 |
$9K |
| 90832 |
Psychotherapy, 30 minutes with patient |
113 |
50 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
113 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
70 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$2K |
| 92015 |
Determination of refractive state |
239 |
220 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
86 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
40 |
27 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
158 |
122 |
$2K |
| 90686 |
|
118 |
104 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| 80305 |
|
136 |
97 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
12 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
39 |
39 |
$830.30 |
| D1110 |
Prophylaxis - adult |
44 |
36 |
$808.55 |
| D0120 |
Periodic oral evaluation - established patient |
61 |
56 |
$737.25 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$567.27 |
| D0274 |
Bitewings - four radiographic images |
58 |
36 |
$523.90 |
| 90688 |
|
18 |
18 |
$257.24 |
| 80053 |
Comprehensive metabolic panel |
14 |
12 |
$115.16 |
| 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 |
29 |
25 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
32 |
30 |
$0.00 |