| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99499 |
|
34,620 |
30,713 |
$3.41M |
| D7999 |
|
17,459 |
4,224 |
$434K |
| D1110 |
Prophylaxis - adult |
1,445 |
1,320 |
$97K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,966 |
1,911 |
$93K |
| 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 |
2,245 |
926 |
$63K |
| D0330 |
Panoramic radiographic image |
1,428 |
1,348 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,083 |
1,016 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,159 |
2,111 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
274 |
248 |
$34K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
310 |
123 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,051 |
993 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
882 |
844 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
927 |
$26K |
| 3074F |
|
301 |
95 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,091 |
1,076 |
$18K |
| 90832 |
Psychotherapy, 30 minutes with patient |
92 |
67 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
176 |
157 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
1,299 |
1,296 |
$13K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
440 |
420 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
41 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
42 |
33 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$196.00 |
| D1330 |
|
402 |
401 |
$0.00 |