| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,436 |
8,758 |
$319K |
| 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 |
1,339 |
1,149 |
$2K |
| D1120 |
Prophylaxis - child |
2,875 |
2,561 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,759 |
2,416 |
$0.00 |
| 90662 |
|
38 |
33 |
$0.00 |
| D1110 |
Prophylaxis - adult |
352 |
307 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
670 |
584 |
$0.00 |
| D0190 |
|
1,563 |
1,449 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
39 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
35 |
34 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,494 |
1,339 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
940 |
768 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,026 |
889 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,676 |
3,310 |
$0.00 |
| D0603 |
|
337 |
317 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
784 |
666 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
227 |
194 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,659 |
1,289 |
$0.00 |
| D1330 |
|
386 |
295 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
494 |
437 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
293 |
272 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
186 |
96 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
15 |
15 |
$0.00 |
| 0011A |
|
13 |
13 |
$0.00 |
| 91301 |
|
35 |
34 |
$0.00 |
| 36416 |
|
29 |
24 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
49 |
44 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
40 |
15 |
$0.00 |