| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
424 |
414 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,304 |
1,218 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,393 |
1,377 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
753 |
733 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
306 |
289 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
2,780 |
1,311 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
2,989 |
517 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
185 |
156 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
159 |
140 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
251 |
219 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
121 |
115 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
516 |
440 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,539 |
1,531 |
$0.00 |
| D4910 |
|
388 |
379 |
$0.00 |
| D0330 |
Panoramic radiographic image |
47 |
47 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
58 |
57 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
268 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
561 |
374 |
$0.00 |
| D2140 |
|
95 |
71 |
$0.00 |
| D0270 |
|
62 |
62 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
14 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
597 |
579 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,999 |
5,051 |
$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 |
3,053 |
2,294 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
411 |
404 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,413 |
1,393 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,958 |
1,946 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,076 |
1,372 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,768 |
10,416 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
488 |
426 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
558 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
144 |
108 |
$0.00 |
| D2330 |
|
17 |
12 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
60 |
41 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
17 |
16 |
$0.00 |