| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,550 |
5,872 |
$821K |
| D1351 |
Sealant - per tooth |
395 |
67 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,173 |
1,065 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
561 |
561 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
691 |
641 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
313 |
310 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
165 |
$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 |
29 |
27 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
726 |
714 |
$0.00 |
| D0330 |
Panoramic radiographic image |
123 |
123 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
366 |
362 |
$0.00 |
| D1120 |
Prophylaxis - child |
92 |
92 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
29 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
44 |
42 |
$0.00 |
| 99173 |
|
45 |
44 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
18 |
17 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |