| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 80305 |
|
91 |
81 |
$0.00 |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$0.00 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
247 |
231 |
$0.00 |
| D4910 |
|
36 |
36 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
28 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
245 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
220 |
128 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
69 |
69 |
$0.00 |
| 90661 |
|
17 |
17 |
$0.00 |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$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 |
1,161 |
960 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
757 |
696 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
165 |
164 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,227 |
1,101 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
205 |
201 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
47 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
94 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
400 |
373 |
$0.00 |
| 36416 |
|
57 |
56 |
$0.00 |
| 99607 |
|
51 |
41 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
34 |
34 |
$0.00 |
| 99606 |
|
137 |
112 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18 |
18 |
$0.00 |