| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,936 |
2,571 |
$119K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,626 |
1,471 |
$74K |
| D0330 |
Panoramic radiographic image |
1,480 |
1,414 |
$37K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
448 |
279 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
653 |
522 |
$20K |
| D1110 |
Prophylaxis - adult |
631 |
601 |
$14K |
| 99385 |
|
79 |
76 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,237 |
1,180 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
95 |
92 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,303 |
1,753 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
1,149 |
1,087 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
56 |
56 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
328 |
309 |
$4K |
| 99381 |
|
132 |
69 |
$4K |
| D1330 |
|
2,351 |
2,080 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
56 |
$3K |
| D2140 |
|
88 |
61 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,698 |
1,616 |
$2K |
| D1206 |
Topical application of fluoride varnish |
946 |
904 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
32 |
31 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
255 |
226 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,679 |
2,530 |
$1K |
| D0603 |
|
2,032 |
1,908 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
60 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 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 |
237 |
182 |
$992.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
57 |
$939.85 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
80 |
74 |
$910.00 |
| 99442 |
|
55 |
47 |
$741.30 |
| 82948 |
|
789 |
708 |
$642.83 |
| D4341 |
|
41 |
26 |
$518.59 |
| D1310 |
|
2,024 |
1,766 |
$506.13 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
70 |
67 |
$151.24 |
| 90686 |
|
44 |
38 |
$129.68 |
| 90656 |
|
13 |
12 |
$104.01 |
| D1120 |
Prophylaxis - child |
36 |
36 |
$85.83 |
| 3044F |
|
590 |
544 |
$80.00 |
| 3008F |
|
3,120 |
2,745 |
$47.36 |
| 3074F |
|
1,738 |
1,630 |
$25.00 |
| 81002 |
|
26 |
24 |
$19.93 |
| 3075F |
|
231 |
224 |
$0.00 |
| 3351F |
|
3,194 |
2,801 |
$0.00 |
| 3079F |
|
772 |
684 |
$0.00 |
| 1111F |
|
13 |
13 |
$0.00 |
| 1126F |
|
29 |
29 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
13 |
13 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |
| 1170F |
|
13 |
13 |
$0.00 |
| D9993 |
|
1,587 |
1,505 |
$0.00 |
| 3725F |
|
3,274 |
2,878 |
$0.00 |
| 3078F |
|
1,753 |
1,536 |
$0.00 |
| 1160F |
|
330 |
309 |
$0.00 |
| 1159F |
|
344 |
322 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| D1354 |
|
14 |
12 |
$0.00 |