| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,548 |
2,375 |
$189K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,432 |
1,325 |
$143K |
| D0330 |
Panoramic radiographic image |
43 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
92 |
88 |
$3K |
| 86803 |
|
26 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$960.48 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$945.12 |
| 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 |
28 |
27 |
$888.67 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$832.75 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
28 |
27 |
$731.98 |
| 86703 |
|
16 |
16 |
$695.56 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
33 |
32 |
$410.25 |
| 81025 |
|
34 |
24 |
$406.52 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$322.77 |
| 80305 |
|
18 |
17 |
$138.45 |