| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
53,673 |
44,136 |
$14.26M |
| 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 |
47 |
40 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,981 |
17,401 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
944 |
507 |
$584.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,251 |
4,747 |
$391.84 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
669 |
398 |
$132.00 |
| D1110 |
Prophylaxis - adult |
681 |
678 |
$112.80 |
| D0330 |
Panoramic radiographic image |
363 |
359 |
$88.80 |
| 90686 |
|
12 |
12 |
$66.22 |
| D0120 |
Periodic oral evaluation - established patient |
1,166 |
1,150 |
$64.00 |
| D0274 |
Bitewings - four radiographic images |
862 |
852 |
$61.60 |
| D0140 |
Limited oral evaluation - problem focused |
496 |
465 |
$55.22 |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
391 |
$45.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
552 |
$44.00 |
| D0220 |
Intraoral - periapical first radiographic image |
854 |
821 |
$33.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
463 |
382 |
$25.60 |
| D1330 |
|
710 |
692 |
$10.00 |
| D1206 |
Topical application of fluoride varnish |
1,080 |
1,060 |
$0.00 |
| D5899 |
|
448 |
335 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
205 |
195 |
$0.00 |
| 82962 |
|
81 |
79 |
$0.00 |
| D0602 |
|
180 |
180 |
$0.00 |
| D9995 |
|
38 |
38 |
$0.00 |
| D0603 |
|
471 |
461 |
$0.00 |
| 99441 |
|
30 |
28 |
$0.00 |
| 90656 |
|
16 |
16 |
$0.00 |
| D1320 |
|
25 |
24 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
44 |
$0.00 |
| 99349 |
|
41 |
31 |
$0.00 |
| 92551 |
|
25 |
17 |
$0.00 |
| D1351 |
Sealant - per tooth |
40 |
12 |
$0.00 |
| 99188 |
|
30 |
26 |
$0.00 |
| 99347 |
|
51 |
41 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
197 |
181 |
$0.00 |
| D1120 |
Prophylaxis - child |
287 |
277 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
328 |
207 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
30 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
225 |
205 |
$0.00 |
| D0270 |
|
169 |
165 |
$0.00 |
| 99442 |
|
20 |
19 |
$0.00 |
| 99348 |
|
335 |
246 |
$0.00 |
| 99499 |
|
81 |
77 |
$0.00 |
| 99173 |
|
53 |
42 |
$0.00 |
| D4910 |
|
12 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$0.00 |
| D1354 |
|
26 |
14 |
$0.00 |