| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
5,034 |
4,081 |
$999K |
| T1015 |
Clinic visit/encounter, all-inclusive |
883 |
605 |
$72K |
| 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 |
347 |
293 |
$14K |
| D1999 |
|
41 |
35 |
$7K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
132 |
67 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
152 |
140 |
$263.23 |
| 90834 |
Psychotherapy, 45 minutes with patient |
347 |
231 |
$31.32 |
| D1110 |
Prophylaxis - adult |
402 |
401 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
111 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
681 |
658 |
$0.00 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
230 |
229 |
$0.00 |
| D1120 |
Prophylaxis - child |
121 |
121 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
494 |
493 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
3,650 |
2,944 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
319 |
319 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
414 |
414 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
494 |
477 |
$0.00 |
| D0603 |
|
212 |
212 |
$0.00 |
| D0601 |
|
40 |
40 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
196 |
149 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
142 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
62 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
185 |
$0.00 |
| D0602 |
|
69 |
69 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
26 |
13 |
$0.00 |