| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,355 |
16,625 |
$5.37M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
770 |
682 |
$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 |
14 |
14 |
$396.90 |
| D1110 |
Prophylaxis - adult |
833 |
820 |
$134.90 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
424 |
420 |
$57.48 |
| D0120 |
Periodic oral evaluation - established patient |
482 |
474 |
$25.41 |
| D0274 |
Bitewings - four radiographic images |
516 |
511 |
$0.00 |
| 99173 |
|
27 |
27 |
$0.00 |
| 3725F |
|
289 |
270 |
$0.00 |
| D0330 |
Panoramic radiographic image |
294 |
293 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
85 |
$0.00 |
| 1160F |
|
113 |
104 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
190 |
$0.00 |
| D0431 |
|
185 |
174 |
$0.00 |
| 3078F |
|
159 |
141 |
$0.00 |
| D1120 |
Prophylaxis - child |
26 |
26 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
282 |
264 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
160 |
160 |
$0.00 |
| 3008F |
|
1,237 |
1,102 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
197 |
$0.00 |
| D0602 |
|
183 |
177 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
128 |
128 |
$0.00 |
| 3074F |
|
287 |
260 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
39 |
31 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
27 |
27 |
$0.00 |
| 97802 |
|
19 |
17 |
$0.00 |
| 90686 |
|
18 |
15 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
18 |
16 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
15 |
$0.00 |