| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,994 |
19,498 |
$744K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,414 |
9,202 |
$248K |
| D1120 |
Prophylaxis - child |
6,146 |
5,993 |
$227K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,726 |
1,687 |
$118K |
| D1206 |
Topical application of fluoride varnish |
5,830 |
5,702 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,498 |
$77K |
| D1351 |
Sealant - per tooth |
3,710 |
1,453 |
$65K |
| D0272 |
Bitewings - two radiographic images |
3,592 |
3,525 |
$65K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,619 |
832 |
$59K |
| D1110 |
Prophylaxis - adult |
1,302 |
1,269 |
$56K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
1,521 |
1,395 |
$48K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
3,784 |
1,830 |
$47K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
461 |
445 |
$44K |
| 90837 |
Psychotherapy, 53 minutes with patient |
586 |
424 |
$44K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,251 |
2,572 |
$43K |
| V2020 |
Frames, purchases |
1,680 |
1,628 |
$36K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
681 |
617 |
$30K |
| 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 |
4,386 |
1,324 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,135 |
2,076 |
$26K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,190 |
2,023 |
$25K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
4,240 |
3,991 |
$25K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
677 |
585 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
735 |
640 |
$17K |
| 36415 |
Collection of venous blood by venipuncture |
6,047 |
5,433 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
784 |
760 |
$13K |
| D0330 |
Panoramic radiographic image |
261 |
256 |
$12K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,534 |
1,470 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
345 |
340 |
$10K |
| 90834 |
Psychotherapy, 45 minutes with patient |
195 |
143 |
$9K |
| 92015 |
Determination of refractive state |
2,634 |
2,538 |
$8K |
| 99173 |
|
340 |
302 |
$8K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,796 |
1,650 |
$6K |
| 90785 |
|
425 |
257 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
93 |
87 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
319 |
310 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
372 |
369 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
96 |
88 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
26 |
24 |
$2K |
| 99382 |
|
34 |
34 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
33 |
33 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
63 |
$2K |
| D1330 |
|
3,917 |
3,796 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
176 |
165 |
$1K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
174 |
127 |
$959.59 |
| 90756 |
|
46 |
44 |
$689.10 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
105 |
94 |
$643.68 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$589.40 |
| 80305 |
|
62 |
58 |
$542.76 |
| 90686 |
|
197 |
195 |
$539.29 |
| 90674 |
|
33 |
31 |
$535.43 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
18 |
12 |
$477.23 |
| 92341 |
|
14 |
14 |
$462.00 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
197 |
111 |
$390.07 |
| 90661 |
|
18 |
18 |
$361.62 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
472 |
446 |
$351.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
13 |
$302.26 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$182.00 |
| 81003 |
|
225 |
216 |
$167.37 |
| 92551 |
|
13 |
13 |
$119.34 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
19 |
13 |
$118.58 |
| 36416 |
|
87 |
81 |
$93.32 |
| 81001 |
|
55 |
54 |
$75.71 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
16 |
16 |
$58.94 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13 |
12 |
$22.80 |
| 3044F |
|
475 |
463 |
$2.03 |
| 3078F |
|
99 |
96 |
$0.34 |
| 3074F |
|
58 |
55 |
$0.30 |
| 90633 |
|
36 |
36 |
$0.07 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
2,105 |
1,990 |
$0.01 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
1,475 |
1,333 |
$0.00 |
| 4004F |
|
1,738 |
1,481 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
194 |
184 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
79 |
76 |
$0.00 |
| A4617 |
Mouth piece |
17 |
13 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
1,815 |
1,806 |
$0.00 |
| G8433 |
Screening for depression not completed, documented patient or medical reason |
16 |
16 |
$0.00 |
| 1036F |
|
13 |
12 |
$0.00 |
| D9995 |
|
61 |
59 |
$0.00 |