| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,207 |
2,847 |
$209K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,030 |
1,775 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
247 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
942 |
845 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
967 |
562 |
$26K |
| D0274 |
Bitewings - four radiographic images |
284 |
265 |
$19K |
| 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 |
662 |
614 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
126 |
$12K |
| D1110 |
Prophylaxis - adult |
103 |
98 |
$10K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
63 |
59 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
71 |
66 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$3K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
131 |
112 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
18 |
$2K |
| D0330 |
Panoramic radiographic image |
20 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22 |
12 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$282.48 |
| 99406 |
|
75 |
66 |
$252.56 |
| 99347 |
|
14 |
12 |
$75.11 |
| 3074F |
|
148 |
135 |
$0.00 |
| 1036F |
|
112 |
102 |
$0.00 |
| 1034F |
|
108 |
102 |
$0.00 |
| 3079F |
|
43 |
42 |
$0.00 |
| 3008F |
|
216 |
205 |
$0.00 |
| 1160F |
|
245 |
231 |
$0.00 |
| 3078F |
|
86 |
77 |
$0.00 |
| 1159F |
|
245 |
231 |
$0.00 |