| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,087 |
6,129 |
$721K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,296 |
2,035 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
2,808 |
2,330 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,607 |
1,005 |
$34K |
| D1110 |
Prophylaxis - adult |
350 |
330 |
$26K |
| D0274 |
Bitewings - four radiographic images |
453 |
420 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
507 |
480 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
341 |
265 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
46 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
173 |
$13K |
| 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 |
427 |
390 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
51 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
237 |
220 |
$841.72 |
| D9996 |
|
46 |
46 |
$262.20 |
| 36415 |
Collection of venous blood by venipuncture |
37 |
35 |
$75.00 |
| FEE40 |
|
370 |
272 |
$0.00 |
| 3008F |
|
557 |
503 |
$0.00 |
| 99406 |
|
61 |
57 |
$0.00 |
| 1034F |
|
209 |
192 |
$0.00 |
| 3074F |
|
281 |
262 |
$0.00 |
| 1036F |
|
167 |
147 |
$0.00 |
| 3079F |
|
63 |
59 |
$0.00 |
| 3075F |
|
13 |
12 |
$0.00 |
| 1159F |
|
668 |
561 |
$0.00 |
| 3725F |
|
226 |
204 |
$0.00 |
| 1160F |
|
667 |
560 |
$0.00 |
| 3078F |
|
237 |
215 |
$0.00 |