| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,240 |
3,815 |
$340K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,750 |
2,546 |
$332K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
501 |
489 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
82 |
76 |
$13K |
| 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 |
359 |
302 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
182 |
$5K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$4K |
| D0274 |
Bitewings - four radiographic images |
74 |
69 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
27 |
$905.28 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$898.66 |
| G9920 |
Screening performed and negative |
312 |
295 |
$0.00 |
| G9919 |
Screening performed and positive and provision of recommendations |
18 |
17 |
$0.00 |