| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
8,312 |
6,879 |
$1.71M |
| 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 |
2,044 |
1,716 |
$38K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
876 |
790 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
218 |
192 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
52 |
$337.26 |
| D0140 |
Limited oral evaluation - problem focused |
186 |
180 |
$173.64 |
| D1208 |
Topical application of fluoride, excluding varnish |
318 |
318 |
$0.00 |
| D1330 |
|
72 |
72 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
186 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |
| D1120 |
Prophylaxis - child |
416 |
416 |
$0.00 |
| D1110 |
Prophylaxis - adult |
313 |
312 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$0.00 |