| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,684 |
3,339 |
$231K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
394 |
$41K |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
480 |
471 |
$35K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,040 |
1,893 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
243 |
$8K |
| D1110 |
Prophylaxis - adult |
79 |
78 |
$6K |
| D4355 |
|
43 |
43 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
729 |
567 |
$5K |
| D1120 |
Prophylaxis - child |
107 |
107 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
733 |
697 |
$3K |
| D1206 |
Topical application of fluoride varnish |
164 |
164 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
178 |
174 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
972 |
934 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
855 |
816 |
$2K |
| 81025 |
|
681 |
643 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
123 |
123 |
$2K |
| 83655 |
|
243 |
236 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$751.71 |
| 99382 |
|
13 |
13 |
$653.52 |
| 81002 |
|
768 |
716 |
$606.30 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
29 |
28 |
$406.70 |
| 92567 |
|
313 |
308 |
$262.52 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$241.17 |
| 99406 |
|
58 |
57 |
$149.76 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
13 |
13 |
$146.22 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
41 |
$141.00 |
| 92551 |
|
39 |
39 |
$124.26 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
35 |
35 |
$112.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
26 |
24 |
$111.72 |
| 36415 |
Collection of venous blood by venipuncture |
44 |
43 |
$40.50 |
| 96127 |
|
33 |
31 |
$24.99 |
| 81001 |
|
17 |
17 |
$14.60 |
| 3008F |
|
12 |
12 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 94760 |
|
35 |
34 |
$0.00 |
| 90680 |
|
16 |
14 |
$0.00 |
| 90647 |
|
13 |
13 |
$0.00 |
| 90656 |
|
27 |
27 |
$0.00 |
| 90670 |
|
52 |
52 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
27 |
$0.00 |
| 90633 |
|
13 |
13 |
$0.00 |
| 80061 |
Lipid panel |
12 |
12 |
$0.00 |
| 90461 |
|
19 |
19 |
$0.00 |