| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,816 |
9,752 |
$1.71M |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,822 |
2,599 |
$435K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,554 |
2,374 |
$373K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
725 |
700 |
$131K |
| D1206 |
Topical application of fluoride varnish |
1,804 |
1,773 |
$128K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
693 |
681 |
$126K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
703 |
688 |
$111K |
| D1110 |
Prophylaxis - adult |
526 |
517 |
$58K |
| D1120 |
Prophylaxis - child |
371 |
367 |
$55K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
243 |
240 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
336 |
315 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
189 |
187 |
$20K |
| 99383 |
|
111 |
109 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
828 |
793 |
$19K |
| D0330 |
Panoramic radiographic image |
246 |
242 |
$16K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
102 |
94 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
113 |
$13K |
| 92002 |
|
73 |
68 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
52 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
53 |
51 |
$9K |
| 90832 |
Psychotherapy, 30 minutes with patient |
48 |
47 |
$8K |
| 92015 |
Determination of refractive state |
2,919 |
2,698 |
$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 |
1,932 |
1,542 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
29 |
29 |
$5K |
| 99384 |
|
18 |
18 |
$3K |
| 99499 |
|
603 |
588 |
$2K |
| 99382 |
|
12 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,453 |
472 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,315 |
2,272 |
$570.86 |
| D0274 |
Bitewings - four radiographic images |
338 |
334 |
$188.15 |
| 90651 |
|
420 |
408 |
$185.55 |
| 81025 |
|
213 |
207 |
$5.57 |
| 81003 |
|
959 |
930 |
$1.00 |
| 90686 |
|
767 |
747 |
$0.03 |
| 90633 |
|
104 |
102 |
$0.00 |
| 90715 |
|
130 |
128 |
$0.00 |
| 90700 |
|
30 |
30 |
$0.00 |
| 90734 |
|
323 |
314 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
473 |
461 |
$0.00 |
| 90461 |
|
1,295 |
1,270 |
$0.00 |
| 82948 |
|
188 |
173 |
$0.00 |
| 90685 |
|
25 |
25 |
$0.00 |
| 90670 |
|
51 |
51 |
$0.00 |
| 90710 |
|
43 |
43 |
$0.00 |
| 90620 |
|
95 |
94 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
46 |
45 |
$0.00 |
| 90619 |
|
89 |
88 |
$0.00 |
| 90698 |
|
24 |
24 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
25 |
25 |
$0.00 |
| 90744 |
|
26 |
26 |
$0.00 |