| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,983 |
3,712 |
$88K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,014 |
1,932 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
578 |
556 |
$22K |
| T1015 |
Clinic visit/encounter, all-inclusive |
125 |
115 |
$18K |
| D1110 |
Prophylaxis - adult |
282 |
280 |
$7K |
| 99442 |
|
361 |
343 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
173 |
173 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
669 |
662 |
$4K |
| D1120 |
Prophylaxis - child |
130 |
130 |
$3K |
| 90674 |
|
129 |
128 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
479 |
478 |
$2K |
| 99443 |
|
199 |
192 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
181 |
173 |
$2K |
| D0274 |
Bitewings - four radiographic images |
87 |
87 |
$1K |
| 90688 |
|
37 |
37 |
$935.18 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$756.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$700.00 |
| 99441 |
|
13 |
13 |
$228.90 |
| 3008F |
|
20 |
19 |
$0.00 |
| D1330 |
|
31 |
29 |
$0.00 |
| 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 |
41 |
37 |
$0.00 |
| 1160F |
|
16 |
15 |
$0.00 |
| 1159F |
|
16 |
15 |
$0.00 |
| 3078F |
|
14 |
13 |
$0.00 |