| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,212 |
22,732 |
$3.86M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,784 |
1,469 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,008 |
924 |
$10K |
| 0012A |
|
24 |
24 |
$960.00 |
| D0140 |
Limited oral evaluation - problem focused |
322 |
305 |
$662.64 |
| 0011A |
|
27 |
21 |
$373.80 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
581 |
$240.00 |
| 91301 |
|
43 |
42 |
$0.01 |
| D0120 |
Periodic oral evaluation - established patient |
2,356 |
2,296 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,114 |
1,112 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,095 |
1,080 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
529 |
319 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,614 |
1,579 |
$0.00 |
| D1351 |
Sealant - per tooth |
162 |
26 |
$0.00 |
| D2331 |
|
37 |
28 |
$0.00 |
| D1330 |
|
260 |
259 |
$0.00 |
| D9995 |
|
34 |
30 |
$0.00 |
| 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 |
78 |
56 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
88 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,654 |
2,578 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
139 |
117 |
$0.00 |
| 80305 |
|
824 |
636 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
734 |
547 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,304 |
1,286 |
$0.00 |
| D1120 |
Prophylaxis - child |
938 |
937 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,418 |
1,348 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
163 |
159 |
$0.00 |