| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,955 |
10,954 |
$2.00M |
| 99199 |
Unlisted special service, procedure or report |
32,282 |
12,723 |
$173K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,510 |
1,119 |
$46K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,507 |
1,187 |
$37K |
| 80305 |
|
800 |
553 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
130 |
49 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
201 |
128 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
70 |
$3K |
| D0330 |
Panoramic radiographic image |
32 |
29 |
$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 |
46 |
30 |
$963.96 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
43 |
$678.40 |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$587.30 |
| D1120 |
Prophylaxis - child |
17 |
17 |
$426.90 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$234.85 |
| 36415 |
Collection of venous blood by venipuncture |
16 |
14 |
$36.14 |
| 3078F |
|
102 |
93 |
$0.00 |
| 3079F |
|
99 |
96 |
$0.00 |
| 99000 |
|
311 |
255 |
$0.00 |
| 3074F |
|
166 |
156 |
$0.00 |
| 3075F |
|
15 |
15 |
$0.00 |