| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,025 |
13,656 |
$1.67M |
| 99199 |
Unlisted special service, procedure or report |
70,580 |
39,190 |
$441K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,769 |
777 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,181 |
1,025 |
$15K |
| D0330 |
Panoramic radiographic image |
324 |
292 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
685 |
596 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
300 |
$13K |
| D0274 |
Bitewings - four radiographic images |
422 |
377 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
73 |
$11K |
| D1110 |
Prophylaxis - adult |
280 |
230 |
$8K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
474 |
421 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,738 |
1,600 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
115 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D4346 |
|
39 |
38 |
$1K |
| 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 |
81 |
76 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
26 |
$703.70 |
| D0273 |
|
15 |
12 |
$264.20 |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$232.20 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
532 |
499 |
$136.97 |
| 3725F |
|
395 |
379 |
$0.00 |
| 3078F |
|
98 |
97 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
30 |
26 |
$0.00 |
| 3074F |
|
98 |
97 |
$0.00 |
| 3079F |
|
13 |
12 |
$0.00 |
| 36416 |
|
13 |
12 |
$0.00 |
| 96127 |
|
48 |
40 |
$0.00 |