| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
364 |
302 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
41 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
588 |
242 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
510 |
$17K |
| D0330 |
Panoramic radiographic image |
125 |
121 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
138 |
89 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
90 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
150 |
144 |
$8K |
| D0274 |
Bitewings - four radiographic images |
95 |
90 |
$6K |
| D1110 |
Prophylaxis - adult |
62 |
57 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$2K |
| 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 |
47 |
42 |
$941.60 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
13 |
$3.00 |
| D1999 |
|
48 |
43 |
$0.00 |