| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,077 |
3,884 |
$363K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,971 |
2,620 |
$61K |
| D0330 |
Panoramic radiographic image |
289 |
190 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
298 |
197 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
790 |
515 |
$5K |
| D1110 |
Prophylaxis - adult |
477 |
341 |
$4K |
| 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 |
189 |
159 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
427 |
304 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
139 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
544 |
$1K |
| 82948 |
|
288 |
233 |
$547.46 |
| D0274 |
Bitewings - four radiographic images |
306 |
255 |
$401.68 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
57 |
44 |
$276.72 |
| D1120 |
Prophylaxis - child |
24 |
13 |
$220.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
38 |
27 |
$180.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
57 |
$153.63 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
25 |
$25.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$0.00 |