| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,198 |
5,371 |
$215K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,612 |
2,049 |
$78K |
| 90837 |
Psychotherapy, 53 minutes with patient |
911 |
385 |
$28K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
368 |
225 |
$20K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
485 |
441 |
$7K |
| 80305 |
|
1,361 |
898 |
$6K |
| 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 |
997 |
739 |
$4K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
436 |
222 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
58 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$483.36 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
87 |
$380.98 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$281.13 |
| 0012A |
|
12 |
12 |
$240.00 |
| 99442 |
|
24 |
24 |
$211.80 |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$192.54 |
| 81025 |
|
158 |
74 |
$161.02 |
| 36415 |
Collection of venous blood by venipuncture |
694 |
572 |
$147.07 |
| 99406 |
|
16 |
14 |
$116.36 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$92.31 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
12 |
12 |
$70.90 |
| 90686 |
|
96 |
83 |
$25.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
12 |
$12.57 |
| 4004F |
|
14 |
12 |
$0.00 |
| 3008F |
|
3,006 |
1,830 |
$0.00 |
| 1220F |
|
696 |
349 |
$0.00 |
| 1000F |
|
954 |
439 |
$0.00 |
| 1036F |
|
422 |
266 |
$0.00 |
| 3351F |
|
870 |
617 |
$0.00 |
| 90656 |
|
48 |
48 |
$0.00 |
| 97802 |
|
12 |
12 |
$0.00 |
| 96127 |
|
35 |
31 |
$0.00 |
| 3352F |
|
17 |
14 |
$0.00 |
| 1034F |
|
22 |
17 |
$0.00 |