| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,630 |
8,393 |
$775K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,356 |
7,540 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,603 |
1,284 |
$42K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,027 |
506 |
$31K |
| D0330 |
Panoramic radiographic image |
1,347 |
976 |
$25K |
| D1110 |
Prophylaxis - adult |
683 |
552 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,036 |
868 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,407 |
1,041 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
168 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
833 |
772 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
3,010 |
2,308 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
671 |
379 |
$9K |
| 99441 |
|
1,004 |
504 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,157 |
1,318 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
770 |
383 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
145 |
$5K |
| 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 |
384 |
337 |
$5K |
| 90674 |
|
350 |
171 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
925 |
340 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
221 |
156 |
$4K |
| 90686 |
|
248 |
139 |
$2K |
| 90756 |
|
154 |
86 |
$2K |
| 99442 |
|
143 |
75 |
$2K |
| D1120 |
Prophylaxis - child |
77 |
65 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
295 |
165 |
$1K |
| D0272 |
Bitewings - two radiographic images |
91 |
77 |
$800.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$405.00 |
| 90688 |
|
39 |
20 |
$375.02 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
73 |
38 |
$182.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
254 |
132 |
$131.24 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
19 |
12 |
$96.63 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
39 |
16 |
$23.41 |
| 4004F |
|
6,602 |
3,267 |
$0.00 |
| 3078F |
|
5,188 |
2,622 |
$0.00 |
| 3077F |
|
1,695 |
867 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
176 |
72 |
$0.00 |
| 1036F |
|
5,651 |
2,832 |
$0.00 |
| 3074F |
|
6,909 |
3,487 |
$0.00 |
| 3079F |
|
3,961 |
2,026 |
$0.00 |
| D0603 |
|
625 |
459 |
$0.00 |
| 3075F |
|
1,556 |
781 |
$0.00 |
| 3080F |
|
1,335 |
699 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
185 |
76 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
28 |
17 |
$0.00 |
| D0602 |
|
29 |
29 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |