| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,488 |
3,271 |
$395K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,600 |
3,276 |
$271K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
782 |
767 |
$27K |
| 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 |
348 |
307 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
27 |
25 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
14 |
$3K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
99 |
$3K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
27 |
24 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$1K |
| G9920 |
Screening performed and negative |
144 |
139 |
$0.00 |
| 4004F |
|
12 |
12 |
$0.00 |
| G9919 |
Screening performed and positive and provision of recommendations |
27 |
27 |
$0.00 |