| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,215 |
3,575 |
$763K |
| D1120 |
Prophylaxis - child |
2,340 |
2,305 |
$364K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,322 |
881 |
$323K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,275 |
879 |
$293K |
| D1206 |
Topical application of fluoride varnish |
3,210 |
3,147 |
$263K |
| D1110 |
Prophylaxis - adult |
1,140 |
1,122 |
$178K |
| G9148 |
National committee for quality assurance - level 1 medical home |
511 |
505 |
$155K |
| D0330 |
Panoramic radiographic image |
522 |
512 |
$82K |
| D1351 |
Sealant - per tooth |
2,758 |
602 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
494 |
$68K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
233 |
233 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,653 |
1,626 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
653 |
642 |
$53K |
| 90837 |
Psychotherapy, 53 minutes with patient |
230 |
155 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
417 |
208 |
$35K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
160 |
154 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
160 |
$27K |
| S0311 |
Comprehensive management and care coordination for advanced illness, per calendar month |
72 |
67 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
104 |
$15K |
| S0221 |
Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 60 minutes |
33 |
33 |
$10K |
| D0274 |
Bitewings - four radiographic images |
518 |
512 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
331 |
330 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
630 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
170 |
155 |
$657.62 |
| D1330 |
|
2,627 |
2,554 |
$637.86 |
| D0602 |
|
122 |
120 |
$199.66 |
| D0272 |
Bitewings - two radiographic images |
195 |
195 |
$184.19 |
| 90686 |
|
97 |
90 |
$13.46 |
| D0190 |
|
21 |
20 |
$0.00 |
| D0191 |
|
620 |
614 |
$0.00 |
| 81025 |
|
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
51 |
$0.00 |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
79 |
73 |
$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 |
208 |
155 |
$0.00 |
| D0603 |
|
82 |
74 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
51 |
45 |
$0.00 |
| 82962 |
|
12 |
12 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |