| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,590 |
1,381 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
433 |
380 |
$22K |
| 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 |
859 |
777 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
144 |
121 |
$8K |
| D1110 |
Prophylaxis - adult |
65 |
64 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
178 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
85 |
72 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
29 |
$633.10 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$623.77 |
| 99307 |
|
41 |
38 |
$115.92 |
| D1330 |
|
14 |
14 |
$0.00 |