| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90834 |
Psychotherapy, 45 minutes with patient |
3,065 |
1,581 |
$197K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,123 |
2,739 |
$183K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,543 |
2,339 |
$177K |
| 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 |
1,078 |
873 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
317 |
53 |
$10K |
| 3074F |
|
1,008 |
927 |
$7K |
| 3078F |
|
937 |
878 |
$6K |
| D0330 |
Panoramic radiographic image |
196 |
119 |
$6K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
144 |
135 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
178 |
109 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
33 |
28 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
1,676 |
1,525 |
$2K |
| 99000 |
|
1,010 |
948 |
$2K |
| 3079F |
|
232 |
220 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
13 |
13 |
$2K |
| 87428 |
|
51 |
48 |
$1K |
| 99442 |
|
40 |
31 |
$1K |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
79 |
71 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
69 |
68 |
$877.52 |
| D1120 |
Prophylaxis - child |
26 |
26 |
$871.52 |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
71 |
$804.96 |
| 99177 |
|
213 |
199 |
$793.55 |
| D0120 |
Periodic oral evaluation - established patient |
37 |
37 |
$664.95 |
| 92587 |
|
51 |
51 |
$658.64 |
| 87430 |
|
58 |
54 |
$658.48 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
17 |
15 |
$648.01 |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$644.49 |
| 90832 |
Psychotherapy, 30 minutes with patient |
18 |
12 |
$642.32 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
94 |
87 |
$601.75 |
| 80305 |
|
54 |
39 |
$592.20 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
74 |
70 |
$580.16 |
| D0274 |
Bitewings - four radiographic images |
28 |
27 |
$524.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
71 |
14 |
$480.74 |
| 90656 |
|
18 |
15 |
$305.16 |
| 90686 |
|
15 |
15 |
$165.00 |
| 96127 |
|
42 |
37 |
$146.24 |
| 87807 |
|
12 |
12 |
$145.29 |
| 3075F |
|
15 |
15 |
$125.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
131 |
123 |
$77.60 |
| 99072 |
|
394 |
361 |
$28.22 |
| 36416 |
|
63 |
59 |
$2.01 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
25 |
25 |
$0.00 |