| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,519 |
15,701 |
$3.33M |
| D0120 |
Periodic oral evaluation - established patient |
3,281 |
2,236 |
$471K |
| D7140 |
Extraction, erupted tooth or exposed root |
567 |
472 |
$2K |
| D0274 |
Bitewings - four radiographic images |
430 |
430 |
$804.00 |
| D0140 |
Limited oral evaluation - problem focused |
605 |
572 |
$800.00 |
| D1110 |
Prophylaxis - adult |
159 |
159 |
$747.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
300 |
$535.00 |
| D0220 |
Intraoral - periapical first radiographic image |
759 |
741 |
$459.75 |
| D1120 |
Prophylaxis - child |
67 |
67 |
$406.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
84 |
84 |
$320.00 |
| 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 |
5,889 |
4,617 |
$236.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
594 |
339 |
$176.25 |
| D0330 |
Panoramic radiographic image |
344 |
340 |
$141.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,988 |
2,768 |
$62.77 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,346 |
3,975 |
$41.73 |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,133 |
4,205 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,646 |
2,197 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
738 |
732 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,570 |
1,557 |
$0.00 |
| 90670 |
|
226 |
226 |
$0.00 |
| 99173 |
|
301 |
299 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
96 |
96 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
478 |
476 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
54 |
54 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
38 |
38 |
$0.00 |
| 11721 |
|
116 |
83 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$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 |
34 |
31 |
$0.00 |
| 90687 |
|
14 |
14 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90744 |
|
55 |
55 |
$0.00 |
| 99381 |
|
314 |
313 |
$0.00 |
| 90686 |
|
114 |
114 |
$0.00 |
| 92551 |
|
472 |
472 |
$0.00 |
| 90656 |
|
33 |
33 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
991 |
980 |
$0.00 |
| 82962 |
|
192 |
174 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
162 |
133 |
$0.00 |
| 90688 |
|
61 |
61 |
$0.00 |
| 90647 |
|
12 |
12 |
$0.00 |
| 90677 |
|
46 |
46 |
$0.00 |
| 99384 |
|
12 |
12 |
$0.00 |
| 90680 |
|
80 |
80 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |
| 90698 |
|
46 |
46 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
29 |
29 |
$0.00 |