| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,689 |
5,704 |
$856K |
| D9450 |
|
9,356 |
5,066 |
$268K |
| D1110 |
Prophylaxis - adult |
3,121 |
2,182 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,125 |
611 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
2,091 |
1,621 |
$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 |
757 |
607 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
580 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,756 |
1,573 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
663 |
344 |
$13K |
| D0274 |
Bitewings - four radiographic images |
543 |
405 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
127 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
204 |
$3K |
| 90756 |
|
68 |
68 |
$1K |
| 90480 |
|
27 |
27 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
13 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
410 |
398 |
$966.19 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$433.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
17 |
12 |
$255.45 |
| 90715 |
|
12 |
12 |
$32.86 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12 |
12 |
$23.29 |
| D1999 |
|
1,558 |
667 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
49 |
48 |
$0.00 |
| D4341 |
|
74 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
31 |
31 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,172 |
1,089 |
$0.00 |
| 94760 |
|
899 |
819 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
20 |
20 |
$0.00 |
| 98967 |
|
14 |
14 |
$0.00 |