| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,360 |
2,069 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
651 |
651 |
$42K |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
510 |
508 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
207 |
$39K |
| 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 |
491 |
261 |
$35K |
| D1110 |
Prophylaxis - adult |
464 |
464 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
351 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
211 |
208 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
66 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
335 |
335 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
38 |
$6K |
| D0274 |
Bitewings - four radiographic images |
185 |
185 |
$5K |
| D2950 |
|
34 |
28 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,127 |
1,037 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
262 |
$4K |
| D1120 |
Prophylaxis - child |
79 |
79 |
$3K |
| 90837 |
Psychotherapy, 53 minutes with patient |
239 |
133 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
15 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
806 |
756 |
$3K |
| D1206 |
Topical application of fluoride varnish |
77 |
77 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
74 |
$758.67 |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$593.20 |
| 96127 |
|
894 |
799 |
$404.47 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$385.26 |
| 36415 |
Collection of venous blood by venipuncture |
751 |
709 |
$312.76 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
135 |
134 |
$281.11 |
| 90656 |
|
16 |
16 |
$156.45 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
34 |
34 |
$112.14 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
15 |
$106.93 |
| 99385 |
|
12 |
12 |
$99.37 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$91.23 |
| 96160 |
|
138 |
137 |
$36.48 |
| 90686 |
|
35 |
35 |
$0.00 |
| D0603 |
|
39 |
39 |
$0.00 |
| 3079F |
|
13 |
13 |
$0.00 |
| 3077F |
|
27 |
25 |
$0.00 |
| 99173 |
|
13 |
13 |
$0.00 |