| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,754 |
7,968 |
$823K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,322 |
2,960 |
$125K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,409 |
2,797 |
$74K |
| D0330 |
Panoramic radiographic image |
1,314 |
972 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,155 |
1,547 |
$40K |
| D1110 |
Prophylaxis - adult |
1,436 |
1,032 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
375 |
173 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,594 |
1,161 |
$18K |
| D1120 |
Prophylaxis - child |
992 |
746 |
$16K |
| 90832 |
Psychotherapy, 30 minutes with patient |
757 |
397 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
992 |
649 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
908 |
698 |
$13K |
| D0274 |
Bitewings - four radiographic images |
940 |
766 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
165 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
56 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
708 |
$4K |
| 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 |
92 |
80 |
$3K |
| D1351 |
Sealant - per tooth |
111 |
27 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
60 |
42 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21 |
12 |
$765.75 |
| D0272 |
Bitewings - two radiographic images |
103 |
83 |
$686.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
24 |
$348.82 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
13 |
$195.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
47 |
31 |
$180.40 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
29 |
$0.00 |
| D1310 |
|
75 |
67 |
$0.00 |
| D1330 |
|
226 |
202 |
$0.00 |
| D0603 |
|
70 |
63 |
$0.00 |
| D0602 |
|
43 |
40 |
$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 |
27 |
24 |
$0.00 |