| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,376 |
1,093 |
$270K |
| D1206 |
Topical application of fluoride varnish |
773 |
747 |
$89K |
| D1110 |
Prophylaxis - adult |
340 |
326 |
$49K |
| D1120 |
Prophylaxis - child |
315 |
302 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
304 |
299 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
59 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
75 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
29 |
$6K |
| D0274 |
Bitewings - four radiographic images |
168 |
158 |
$4K |
| 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 |
64 |
42 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
65 |
24 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
16 |
$700.14 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
59 |
$630.99 |
| D0272 |
Bitewings - two radiographic images |
46 |
44 |
$627.87 |
| 99000 |
|
366 |
314 |
$350.97 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
103 |
90 |
$37.52 |
| 1159F |
|
202 |
168 |
$0.00 |
| 3210F |
|
161 |
127 |
$0.00 |
| 1160F |
|
202 |
168 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
32 |
29 |
$0.00 |
| 3078F |
|
592 |
457 |
$0.00 |
| D0330 |
Panoramic radiographic image |
33 |
29 |
$0.00 |
| 4004F |
|
33 |
28 |
$0.00 |
| 4000F |
|
142 |
121 |
$0.00 |
| 1000F |
|
772 |
577 |
$0.00 |
| 2000F |
|
840 |
625 |
$0.00 |
| 2001F |
|
896 |
671 |
$0.00 |
| 1125F |
|
397 |
307 |
$0.00 |
| 3008F |
|
913 |
680 |
$0.00 |
| 3074F |
|
618 |
478 |
$0.00 |
| 1126F |
|
415 |
347 |
$0.00 |
| 3079F |
|
92 |
77 |
$0.00 |
| 1220F |
|
350 |
291 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
18 |
14 |
$0.00 |
| 3075F |
|
14 |
14 |
$0.00 |