| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,895 |
19,251 |
$3.80M |
| 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 |
1,706 |
1,561 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,338 |
737 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,245 |
4,575 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,086 |
1,508 |
$2K |
| D1206 |
Topical application of fluoride varnish |
4,481 |
4,336 |
$1K |
| D1110 |
Prophylaxis - adult |
2,703 |
2,546 |
$1K |
| D1120 |
Prophylaxis - child |
3,119 |
3,014 |
$1K |
| 0031A |
|
30 |
29 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
686 |
547 |
$954.08 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,653 |
3,297 |
$918.52 |
| D0120 |
Periodic oral evaluation - established patient |
1,935 |
1,826 |
$709.91 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
152 |
144 |
$694.39 |
| D0140 |
Limited oral evaluation - problem focused |
1,459 |
1,399 |
$667.98 |
| D0220 |
Intraoral - periapical first radiographic image |
992 |
946 |
$610.73 |
| 0012A |
|
12 |
12 |
$447.48 |
| 0011A |
|
12 |
12 |
$447.48 |
| 36415 |
Collection of venous blood by venipuncture |
1,559 |
1,476 |
$386.00 |
| D0330 |
Panoramic radiographic image |
792 |
759 |
$251.93 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
905 |
884 |
$162.28 |
| D0274 |
Bitewings - four radiographic images |
1,405 |
1,331 |
$62.87 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$21.86 |
| D0602 |
|
287 |
252 |
$16.62 |
| D0603 |
|
533 |
488 |
$0.44 |
| D1354 |
|
240 |
197 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
226 |
204 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
170 |
$0.00 |
| D0270 |
|
39 |
38 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
13 |
12 |
$0.00 |
| 90715 |
|
14 |
13 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
41 |
31 |
$0.00 |
| 36416 |
|
150 |
143 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
309 |
249 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
443 |
423 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
127 |
126 |
$0.00 |
| D1351 |
Sealant - per tooth |
61 |
36 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |
| 90688 |
|
21 |
21 |
$0.00 |
| D1330 |
|
29 |
29 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |