| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,207 |
987 |
$154K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,801 |
512 |
$47K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,351 |
1,232 |
$38K |
| 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 |
972 |
930 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,043 |
865 |
$28K |
| D0330 |
Panoramic radiographic image |
209 |
195 |
$23K |
| D0274 |
Bitewings - four radiographic images |
236 |
209 |
$14K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
538 |
392 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
97 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
12 |
$8K |
| D1110 |
Prophylaxis - adult |
64 |
54 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
55 |
52 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
27 |
$2K |
| 96150 |
|
42 |
39 |
$407.38 |