| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
12,933 |
9,367 |
$1.34M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,611 |
15,057 |
$625K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,654 |
4,802 |
$371K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,461 |
4,733 |
$332K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,292 |
1,988 |
$139K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,130 |
1,838 |
$65K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,531 |
2,135 |
$64K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13,583 |
11,440 |
$52K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
699 |
631 |
$43K |
| 99460 |
|
1,268 |
1,108 |
$43K |
| D1110 |
Prophylaxis - adult |
2,189 |
2,135 |
$42K |
| D1120 |
Prophylaxis - child |
1,163 |
1,106 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,832 |
1,562 |
$35K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
269 |
254 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
1,299 |
1,261 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,108 |
2,024 |
$30K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
6,514 |
5,474 |
$28K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
230 |
208 |
$27K |
| 99462 |
|
1,154 |
895 |
$24K |
| 90670 |
|
2,126 |
1,780 |
$22K |
| D0330 |
Panoramic radiographic image |
1,100 |
1,061 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,408 |
2,011 |
$19K |
| 87428 |
|
881 |
844 |
$16K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
881 |
574 |
$14K |
| 59515 |
|
77 |
27 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
139 |
$8K |
| 99381 |
|
55 |
51 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
4,023 |
3,443 |
$6K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
185 |
113 |
$5K |
| 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 |
4,069 |
2,903 |
$5K |
| 81001 |
|
5,243 |
3,630 |
$5K |
| D1330 |
|
5,246 |
4,906 |
$5K |
| 92552 |
|
1,536 |
1,469 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
125 |
65 |
$4K |
| 90686 |
|
4,093 |
3,299 |
$4K |
| 90697 |
|
235 |
216 |
$4K |
| 1000F |
|
14,579 |
11,492 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
54 |
53 |
$3K |
| D0274 |
Bitewings - four radiographic images |
682 |
644 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
67 |
$3K |
| 3074F |
|
7,346 |
5,838 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
60 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,121 |
1,064 |
$2K |
| 99173 |
|
2,537 |
2,095 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
329 |
264 |
$2K |
| D1351 |
Sealant - per tooth |
494 |
101 |
$2K |
| 90677 |
|
390 |
359 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,577 |
2,320 |
$1K |
| 2001F |
|
22,382 |
17,377 |
$1K |
| 2010F |
|
7,840 |
6,088 |
$1K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
550 |
317 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
248 |
236 |
$1K |
| 90474 |
|
480 |
391 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
846 |
674 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
69 |
50 |
$973.86 |
| 99215 |
Prolong outpt/office vis |
13 |
13 |
$853.61 |
| 94760 |
|
1,717 |
1,365 |
$574.50 |
| 90651 |
|
121 |
112 |
$558.53 |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
42 |
32 |
$513.24 |
| 81025 |
|
441 |
422 |
$500.24 |
| 1033F |
|
7,924 |
6,031 |
$441.90 |
| 3078F |
|
6,979 |
5,305 |
$436.50 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
596 |
476 |
$374.19 |
| 92551 |
|
1,739 |
1,396 |
$362.57 |
| 81002 |
|
223 |
144 |
$328.93 |
| 99401 |
|
53 |
42 |
$327.40 |
| 1030F |
|
1,206 |
917 |
$325.16 |
| D0272 |
Bitewings - two radiographic images |
218 |
211 |
$322.68 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
208 |
106 |
$260.41 |
| 1159F |
|
6,168 |
4,448 |
$244.60 |
| 3008F |
|
15,372 |
11,704 |
$237.33 |
| 1160F |
|
6,119 |
4,512 |
$219.27 |
| 90698 |
|
351 |
290 |
$150.00 |
| 90715 |
|
179 |
168 |
$124.17 |
| 99442 |
|
46 |
42 |
$122.00 |
| 96380 |
|
18 |
18 |
$100.00 |
| 90656 |
|
232 |
223 |
$93.56 |
| 0521F |
|
1,200 |
980 |
$80.04 |
| 90682 |
|
21 |
20 |
$69.94 |
| 3079F |
|
73 |
51 |
$62.94 |
| 1126F |
|
8,984 |
7,519 |
$57.69 |
| 90473 |
|
83 |
75 |
$50.00 |
| 1022F |
|
448 |
430 |
$40.00 |
| 90716 |
|
48 |
44 |
$40.00 |
| 90647 |
|
202 |
151 |
$31.50 |
| 3351F |
|
831 |
663 |
$26.14 |
| 90633 |
|
371 |
329 |
$25.22 |
| 90685 |
|
123 |
106 |
$20.00 |
| 4037F |
|
1,062 |
811 |
$20.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
738 |
575 |
$18.41 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$18.15 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
16 |
14 |
$18.08 |
| D1206 |
Topical application of fluoride varnish |
45 |
38 |
$16.00 |
| 1220F |
|
2,297 |
1,929 |
$13.10 |
| 4000F |
|
1,341 |
1,151 |
$12.64 |
| 3044F |
|
231 |
189 |
$12.63 |
| 4035F |
|
894 |
643 |
$10.00 |
| 2000F |
|
7,799 |
5,866 |
$0.03 |
| 1018F |
|
1,312 |
1,146 |
$0.01 |
| 3288F |
|
17 |
15 |
$0.01 |
| 1111F |
|
2,146 |
1,774 |
$0.01 |
| 1101F |
|
32 |
28 |
$0.01 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
43 |
25 |
$0.00 |
| 3210F |
|
449 |
356 |
$0.00 |
| 90681 |
|
352 |
279 |
$0.00 |
| 3511F |
|
587 |
547 |
$0.00 |
| 4040F |
|
339 |
315 |
$0.00 |
| 1158F |
|
636 |
541 |
$0.00 |
| 4025F |
|
13 |
12 |
$0.00 |
| 2014F |
|
465 |
359 |
$0.00 |
| 90707 |
|
65 |
55 |
$0.00 |
| 90700 |
|
68 |
63 |
$0.00 |
| 3725F |
|
347 |
298 |
$0.00 |
| 0502F |
|
2,816 |
2,027 |
$0.00 |
| 2022F |
|
177 |
115 |
$0.00 |
| 92015 |
Determination of refractive state |
156 |
112 |
$0.00 |
| 4148F |
|
117 |
114 |
$0.00 |
| V2025 |
Deluxe frame |
23 |
13 |
$0.00 |
| 90710 |
|
63 |
36 |
$0.00 |
| 90734 |
|
19 |
18 |
$0.00 |
| V2020 |
Frames, purchases |
29 |
25 |
$0.00 |
| 90648 |
|
29 |
27 |
$0.00 |
| D0180 |
|
15 |
15 |
$0.00 |
| 90658 |
|
14 |
12 |
$0.00 |
| D1320 |
|
54 |
40 |
$0.00 |
| 1170F |
|
356 |
273 |
$0.00 |
| 1005F |
|
13 |
12 |
$0.00 |
| 1036F |
|
179 |
136 |
$0.00 |
| 3352F |
|
136 |
97 |
$0.00 |
| 90744 |
|
175 |
151 |
$0.00 |
| 1157F |
|
334 |
139 |
$0.00 |
| 90657 |
|
29 |
29 |
$0.00 |
| D1310 |
|
575 |
497 |
$0.00 |
| 90696 |
|
38 |
13 |
$0.00 |
| 3512F |
|
68 |
62 |
$0.00 |
| 1125F |
|
14 |
13 |
$0.00 |
| 4010F |
|
20 |
12 |
$0.00 |