| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,444 |
11,730 |
$2.43M |
| 99199 |
Unlisted special service, procedure or report |
30,427 |
20,668 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
2,013 |
1,854 |
$48K |
| D1110 |
Prophylaxis - adult |
1,213 |
1,125 |
$42K |
| 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 |
1,916 |
1,544 |
$36K |
| D1120 |
Prophylaxis - child |
1,088 |
955 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
643 |
592 |
$22K |
| 80305 |
|
1,925 |
1,255 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,058 |
944 |
$14K |
| D1206 |
Topical application of fluoride varnish |
883 |
809 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
206 |
$9K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
780 |
676 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
49 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
443 |
383 |
$6K |
| D0274 |
Bitewings - four radiographic images |
203 |
193 |
$6K |
| D0272 |
Bitewings - two radiographic images |
297 |
252 |
$4K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
165 |
76 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
29 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
165 |
120 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$560.20 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,274 |
1,024 |
$505.86 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
22 |
14 |
$289.17 |
| 96127 |
|
122 |
111 |
$197.42 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
425 |
320 |
$60.23 |
| 99490 |
Ccm add 20min |
29 |
29 |
$30.96 |
| 3074F |
|
1,295 |
1,083 |
$1.77 |
| 3078F |
|
820 |
689 |
$1.03 |
| 3079F |
|
421 |
364 |
$0.73 |
| 3075F |
|
73 |
66 |
$0.08 |
| 3077F |
|
13 |
12 |
$0.02 |
| 3080F |
|
34 |
25 |
$0.02 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
23 |
20 |
$0.00 |
| D1330 |
|
31 |
29 |
$0.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
22 |
19 |
$0.00 |
| 91301 |
|
36 |
28 |
$0.00 |