| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,051 |
9,992 |
$670K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,869 |
7,667 |
$223K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,739 |
2,195 |
$99K |
| 99215 |
Prolong outpt/office vis |
1,393 |
659 |
$40K |
| 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 |
1,399 |
1,174 |
$17K |
| S9470 |
Nutritional counseling, dietitian visit |
5,062 |
3,209 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,192 |
847 |
$14K |
| 99406 |
|
3,302 |
2,088 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
624 |
293 |
$10K |
| D1110 |
Prophylaxis - adult |
840 |
561 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
279 |
265 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
527 |
365 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
965 |
596 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
239 |
158 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
693 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
607 |
380 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
70 |
38 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
262 |
84 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
63 |
22 |
$1K |
| 99205 |
Prolong outpt/office vis |
39 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
300 |
185 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
44 |
$820.00 |
| 99385 |
|
25 |
12 |
$751.52 |
| D1206 |
Topical application of fluoride varnish |
492 |
349 |
$720.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
31 |
12 |
$629.31 |
| 90674 |
|
46 |
19 |
$611.28 |
| 90658 |
|
147 |
90 |
$410.20 |
| D0120 |
Periodic oral evaluation - established patient |
404 |
262 |
$409.92 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
55 |
$378.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
50 |
22 |
$338.00 |
| D1120 |
Prophylaxis - child |
198 |
127 |
$300.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
58 |
27 |
$154.00 |
| D0270 |
|
49 |
27 |
$130.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$51.21 |
| D0272 |
Bitewings - two radiographic images |
64 |
43 |
$30.00 |
| 99408 |
|
609 |
417 |
$26.00 |
| 2028F |
|
84 |
75 |
$0.00 |
| 3078F |
|
634 |
352 |
$0.00 |
| D0330 |
Panoramic radiographic image |
53 |
48 |
$0.00 |
| 2014F |
|
125 |
93 |
$0.00 |
| 3077F |
|
41 |
26 |
$0.00 |
| 1036F |
|
610 |
338 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,677 |
1,497 |
$0.00 |
| 3074F |
|
1,187 |
672 |
$0.00 |
| 3008F |
|
1,074 |
650 |
$0.00 |
| S9452 |
Nutrition classes, non-physician provider, per session |
101 |
90 |
$0.00 |
| 1000F |
|
1,975 |
1,794 |
$0.00 |
| 97802 |
|
59 |
28 |
$0.00 |
| 99000 |
|
163 |
160 |
$0.00 |
| 3075F |
|
608 |
330 |
$0.00 |
| 3079F |
|
1,208 |
684 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |