| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,251 |
3,397 |
$74K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
401 |
362 |
$19K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
529 |
449 |
$10K |
| D1206 |
Topical application of fluoride varnish |
141 |
140 |
$2K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$900.90 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$720.49 |
| D0190 |
|
96 |
95 |
$591.13 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$97.04 |
| 36415 |
Collection of venous blood by venipuncture |
56 |
53 |
$39.43 |
| 2000F |
|
466 |
395 |
$14.17 |
| 1160F |
|
550 |
481 |
$0.00 |
| 1159F |
|
547 |
479 |
$0.00 |
| 3078F |
|
114 |
98 |
$0.00 |
| 1000F |
|
672 |
497 |
$0.00 |
| D1330 |
|
141 |
140 |
$0.00 |
| 3008F |
|
524 |
434 |
$0.00 |
| 3074F |
|
155 |
137 |
$0.00 |
| 3351F |
|
121 |
105 |
$0.00 |
| 2010F |
|
86 |
74 |
$0.00 |
| 1220F |
|
561 |
476 |
$0.00 |
| 2001F |
|
759 |
660 |
$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 |
15 |
12 |
$0.00 |
| 1036F |
|
16 |
12 |
$0.00 |
| 3079F |
|
29 |
27 |
$0.00 |
| D1310 |
|
15 |
15 |
$0.00 |
| 3044F |
|
12 |
12 |
$0.00 |