| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,017 |
3,749 |
$622K |
| T1015 |
Clinic visit/encounter, all-inclusive |
5,688 |
2,714 |
$584K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,244 |
2,119 |
$354K |
| D1999 |
|
2,121 |
1,842 |
$20K |
| D1206 |
Topical application of fluoride varnish |
2,125 |
1,827 |
$16K |
| D1120 |
Prophylaxis - child |
1,151 |
1,151 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,333 |
1,333 |
$12K |
| 90686 |
|
667 |
642 |
$10K |
| 36415 |
Collection of venous blood by venipuncture |
1,811 |
1,708 |
$9K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
977 |
930 |
$7K |
| D1110 |
Prophylaxis - adult |
316 |
316 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
455 |
349 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
308 |
$2K |
| D0274 |
Bitewings - four radiographic images |
488 |
488 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
163 |
$2K |
| 90677 |
|
16 |
15 |
$2K |
| 0124A |
|
56 |
51 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
13 |
$2K |
| 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 |
31 |
29 |
$1K |
| 0011A |
|
12 |
12 |
$889.30 |
| D0330 |
Panoramic radiographic image |
410 |
410 |
$756.00 |
| 90480 |
|
17 |
15 |
$501.93 |
| D0272 |
Bitewings - two radiographic images |
190 |
190 |
$364.00 |
| 0001A |
|
14 |
14 |
$363.19 |
| 90656 |
|
17 |
16 |
$198.60 |
| 99173 |
|
33 |
32 |
$60.49 |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
425 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
36 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
559 |
215 |
$0.00 |
| D0240 |
|
15 |
12 |
$0.00 |