| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,469 |
7,721 |
$1.15M |
| D1110 |
Prophylaxis - adult |
4,263 |
1,749 |
$153K |
| 99442 |
|
914 |
851 |
$118K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
903 |
668 |
$89K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
846 |
621 |
$84K |
| 99443 |
|
617 |
573 |
$80K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
578 |
378 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,234 |
657 |
$41K |
| 99441 |
|
278 |
263 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,593 |
1,448 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
701 |
208 |
$30K |
| D1120 |
Prophylaxis - child |
836 |
482 |
$29K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
205 |
198 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
712 |
543 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
452 |
329 |
$14K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
208 |
94 |
$14K |
| D0274 |
Bitewings - four radiographic images |
457 |
433 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
123 |
60 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
552 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
67 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
133 |
133 |
$3K |
| 99215 |
Prolong outpt/office vis |
27 |
16 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
19 |
17 |
$2K |
| 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 |
38 |
16 |
$2K |
| D0270 |
|
87 |
87 |
$736.72 |
| D0602 |
|
310 |
304 |
$141.89 |
| D1330 |
|
540 |
538 |
$0.00 |