| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,176 |
3,473 |
$127K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
756 |
653 |
$32K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
876 |
758 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
105 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
60 |
60 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
73 |
$4K |
| D1110 |
Prophylaxis - adult |
114 |
114 |
$3K |
| D1120 |
Prophylaxis - child |
150 |
150 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
27 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
30 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
105 |
$2K |
| D1206 |
Topical application of fluoride varnish |
268 |
268 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
19 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$945.12 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$395.13 |
| D1330 |
|
231 |
231 |
$389.63 |
| D0274 |
Bitewings - four radiographic images |
36 |
36 |
$67.45 |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
100 |
$18.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
38 |
38 |
$18.00 |
| 82962 |
|
12 |
12 |
$17.84 |
| G8476 |
Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
82 |
66 |
$0.00 |
| D0330 |
Panoramic radiographic image |
57 |
57 |
$0.00 |
| 1160F |
|
32 |
25 |
$0.00 |
| 3078F |
|
15 |
12 |
$0.00 |
| 1159F |
|
98 |
53 |
$0.00 |
| H1000 |
Prenatal care, at-risk assessment |
15 |
12 |
$0.00 |
| 2014F |
|
30 |
13 |
$0.00 |
| 2010F |
|
366 |
239 |
$0.00 |
| D1310 |
|
230 |
230 |
$0.00 |
| 2001F |
|
90 |
53 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |
| 1000F |
|
117 |
101 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
58 |
48 |
$0.00 |
| 3008F |
|
105 |
54 |
$0.00 |
| 1036F |
|
30 |
13 |
$0.00 |
| 3074F |
|
15 |
12 |
$0.00 |
| 2000F |
|
99 |
54 |
$0.00 |
| 1220F |
|
24 |
12 |
$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 |
30 |
25 |
$0.00 |