| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,119 |
16,604 |
$3.50M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,111 |
917 |
$142K |
| 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 |
1,387 |
1,171 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
701 |
$21K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,116 |
2,912 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,102 |
1,953 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
201 |
$3K |
| 99441 |
|
121 |
111 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$887.00 |
| D0330 |
Panoramic radiographic image |
369 |
369 |
$146.31 |
| 36415 |
Collection of venous blood by venipuncture |
58 |
57 |
$70.65 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
416 |
$57.00 |
| 87428 |
|
180 |
178 |
$29.39 |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
312 |
$15.24 |
| D0274 |
Bitewings - four radiographic images |
290 |
290 |
$0.00 |
| D1110 |
Prophylaxis - adult |
176 |
176 |
$0.00 |
| D1120 |
Prophylaxis - child |
97 |
97 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
29 |
28 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
67 |
67 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
25 |
25 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
38 |
37 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
30 |
29 |
$0.00 |