| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
10,701 |
7,741 |
$2.21M |
| 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 |
100 |
87 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
40 |
36 |
$891.04 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
470 |
$0.00 |
| D1330 |
|
587 |
554 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
76 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
19 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
122 |
38 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
257 |
257 |
$0.00 |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
225 |
224 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$0.00 |