| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
550 |
430 |
$70K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,205 |
1,108 |
$57K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
481 |
457 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
226 |
226 |
$1K |
| 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 |
59 |
55 |
$147.49 |
| D0230 |
Intraoral - periapical each additional radiographic image |
368 |
141 |
$121.00 |
| 0071A |
|
21 |
19 |
$120.00 |
| D1110 |
Prophylaxis - adult |
88 |
80 |
$112.00 |
| D0120 |
Periodic oral evaluation - established patient |
150 |
128 |
$104.00 |
| 0001A |
|
17 |
17 |
$80.00 |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
147 |
$56.00 |
| 0002A |
|
15 |
14 |
$40.00 |
| D1206 |
Topical application of fluoride varnish |
158 |
143 |
$36.00 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$36.00 |
| D0602 |
|
177 |
156 |
$0.00 |
| 91307 |
|
44 |
40 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
61 |
61 |
$0.00 |
| D1120 |
Prophylaxis - child |
15 |
12 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
18 |
18 |
$0.00 |
| 91300 |
|
63 |
52 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
16 |
16 |
$0.00 |