| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,777 |
1,370 |
$68K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,620 |
1,276 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
398 |
324 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
542 |
513 |
$11K |
| 92015 |
Determination of refractive state |
732 |
589 |
$5K |
| D1206 |
Topical application of fluoride varnish |
310 |
262 |
$4K |
| 91322 |
|
25 |
24 |
$2K |
| 90686 |
|
133 |
96 |
$2K |
| 90480 |
|
28 |
26 |
$706.88 |
| D1110 |
Prophylaxis - adult |
31 |
28 |
$600.59 |
| 90688 |
|
40 |
23 |
$574.08 |
| D0140 |
Limited oral evaluation - problem focused |
19 |
14 |
$270.70 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
14 |
$249.16 |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
27 |
$214.53 |
| 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 |
87 |
66 |
$0.00 |