| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
7,739 |
6,862 |
$2.71M |
| T1015 |
Clinic visit/encounter, all-inclusive |
7,051 |
5,923 |
$1.62M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
846 |
758 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,011 |
1,802 |
$11K |
| 80053 |
Comprehensive metabolic panel |
40 |
36 |
$440.49 |
| 36415 |
Collection of venous blood by venipuncture |
109 |
94 |
$290.02 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
37 |
36 |
$289.34 |
| 80061 |
Lipid panel |
14 |
13 |
$168.70 |
| 81002 |
|
13 |
12 |
$40.69 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
21 |
13 |
$5.16 |
| D1110 |
Prophylaxis - adult |
1,465 |
1,463 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
129 |
$0.00 |
| 3078F |
|
143 |
129 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
557 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
284 |
283 |
$0.00 |
| D1120 |
Prophylaxis - child |
884 |
884 |
$0.00 |
| 1159F |
|
467 |
430 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
622 |
621 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,845 |
1,844 |
$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 |
434 |
280 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
129 |
$0.00 |
| 3074F |
|
209 |
187 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
461 |
458 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
385 |
384 |
$0.00 |
| 90686 |
|
13 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
51 |
$0.00 |
| 1125F |
|
58 |
54 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
72 |
$0.00 |
| 1126F |
|
34 |
31 |
$0.00 |
| D1351 |
Sealant - per tooth |
96 |
29 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
31 |
31 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,685 |
1,683 |
$-336.24 |