| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,153 |
2,373 |
$59K |
| 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 |
1,770 |
1,293 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
127 |
104 |
$3K |
| D1310 |
|
95 |
94 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$1K |
| D1110 |
Prophylaxis - adult |
18 |
18 |
$839.30 |
| D0120 |
Periodic oral evaluation - established patient |
45 |
44 |
$598.42 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$528.61 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$358.20 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
33 |
$322.88 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$0.00 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$0.00 |
| D1320 |
|
97 |
95 |
$0.00 |
| 94760 |
|
274 |
205 |
$0.00 |
| D1330 |
|
95 |
94 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
103 |
102 |
$0.00 |