| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,552 |
2,141 |
$75K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,050 |
895 |
$44K |
| D1110 |
Prophylaxis - adult |
1,343 |
1,338 |
$39K |
| D0330 |
Panoramic radiographic image |
779 |
765 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,384 |
1,368 |
$23K |
| D1120 |
Prophylaxis - child |
392 |
388 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,139 |
1,117 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
428 |
379 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
1,184 |
1,171 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
813 |
796 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
254 |
137 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,474 |
1,458 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
81 |
$4K |
| D1351 |
Sealant - per tooth |
180 |
45 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
56 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
39 |
33 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
43 |
39 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
32 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
3,230 |
3,158 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
17 |
17 |
$1K |
| 99406 |
|
546 |
476 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$987.11 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,039 |
2,000 |
$801.52 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$742.00 |
| 0012A |
|
12 |
12 |
$480.00 |
| D0272 |
Bitewings - two radiographic images |
147 |
144 |
$260.52 |
| D0603 |
|
1,100 |
1,081 |
$154.00 |
| D1310 |
|
35 |
35 |
$117.42 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
14 |
$100.00 |
| 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 |
289 |
229 |
$46.94 |
| 1125F |
|
1,639 |
1,454 |
$12.61 |
| D1330 |
|
413 |
406 |
$8.92 |
| 97802 |
|
34 |
30 |
$0.26 |
| 1036F |
|
2,233 |
1,928 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
841 |
732 |
$0.00 |
| 1126F |
|
1,280 |
1,163 |
$0.00 |
| 3074F |
|
2,428 |
2,124 |
$0.00 |
| 1000F |
|
3,132 |
2,690 |
$0.00 |
| 1111F |
|
155 |
138 |
$0.00 |
| 3075F |
|
389 |
361 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
370 |
318 |
$0.00 |
| 3080F |
|
152 |
140 |
$0.00 |
| 3079F |
|
835 |
776 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
158 |
140 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
15 |
14 |
$0.00 |
| 4086F |
|
18 |
17 |
$0.00 |
| 4010F |
|
23 |
22 |
$0.00 |
| 96167 |
|
248 |
215 |
$0.00 |
| 3078F |
|
2,306 |
2,000 |
$0.00 |
| 1160F |
|
2,999 |
2,646 |
$0.00 |
| 1158F |
|
1,764 |
1,576 |
$0.00 |
| 1159F |
|
3,002 |
2,648 |
$0.00 |
| 3077F |
|
361 |
336 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
1,614 |
1,415 |
$0.00 |
| 99497 |
|
406 |
371 |
$0.00 |
| 96160 |
|
111 |
104 |
$0.00 |
| D0180 |
|
15 |
15 |
$0.00 |
| 83037 |
|
14 |
12 |
$0.00 |
| 4013F |
|
20 |
19 |
$0.00 |