| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,274 |
7,302 |
$2.05M |
| 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 |
814 |
645 |
$45K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,346 |
1,912 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
637 |
546 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
42 |
36 |
$587.19 |
| 3078F |
|
311 |
267 |
$573.25 |
| D1120 |
Prophylaxis - child |
683 |
664 |
$300.06 |
| 90837 |
Psychotherapy, 53 minutes with patient |
434 |
188 |
$280.72 |
| D0140 |
Limited oral evaluation - problem focused |
605 |
574 |
$249.01 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,118 |
978 |
$241.47 |
| 36415 |
Collection of venous blood by venipuncture |
176 |
162 |
$60.47 |
| 1160F |
|
313 |
256 |
$14.29 |
| 3008F |
|
589 |
488 |
$14.28 |
| 3074F |
|
418 |
342 |
$14.26 |
| 96127 |
|
373 |
285 |
$0.06 |
| 3725F |
|
35 |
21 |
$0.02 |
| D0220 |
Intraoral - periapical first radiographic image |
375 |
354 |
$0.00 |
| D0330 |
Panoramic radiographic image |
85 |
84 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
16 |
15 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
39 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
19 |
19 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
18 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
113 |
109 |
$0.00 |
| D1351 |
Sealant - per tooth |
209 |
198 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
518 |
502 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
842 |
805 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
394 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
261 |
$0.00 |
| 3079F |
|
63 |
50 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
140 |
$0.00 |
| D3120 |
|
62 |
55 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
52 |
38 |
$0.00 |