| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,754 |
11,337 |
$493K |
| D0120 |
Periodic oral evaluation - established patient |
3,732 |
3,572 |
$167K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,569 |
1,418 |
$109K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,564 |
1,355 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,139 |
1,103 |
$53K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,189 |
924 |
$43K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
677 |
623 |
$42K |
| D1110 |
Prophylaxis - adult |
551 |
528 |
$31K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
398 |
385 |
$25K |
| 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 |
5,625 |
4,460 |
$25K |
| 99385 |
|
322 |
260 |
$18K |
| D1206 |
Topical application of fluoride varnish |
4,893 |
4,684 |
$17K |
| D1120 |
Prophylaxis - child |
4,428 |
4,247 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
289 |
273 |
$12K |
| D1351 |
Sealant - per tooth |
1,149 |
404 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
311 |
237 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
145 |
$7K |
| D1330 |
|
5,160 |
4,954 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,669 |
1,415 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
98 |
82 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
284 |
$4K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
179 |
117 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,586 |
2,198 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,218 |
1,141 |
$2K |
| 81025 |
|
1,101 |
919 |
$2K |
| 99386 |
|
15 |
15 |
$2K |
| 99188 |
|
315 |
290 |
$2K |
| 85018 |
|
2,272 |
2,073 |
$2K |
| 99381 |
|
15 |
13 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
92 |
91 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
26 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,450 |
1,348 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,806 |
1,700 |
$1K |
| D0274 |
Bitewings - four radiographic images |
219 |
216 |
$826.04 |
| 93000 |
|
159 |
130 |
$675.54 |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
27 |
$605.00 |
| 81002 |
|
746 |
643 |
$547.64 |
| 82962 |
|
579 |
532 |
$439.97 |
| 3074F |
|
9,559 |
8,017 |
$350.10 |
| 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 |
2,763 |
2,075 |
$347.56 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
81 |
56 |
$174.34 |
| 90688 |
|
35 |
34 |
$137.74 |
| 90680 |
|
460 |
379 |
$75.40 |
| D0270 |
|
26 |
26 |
$34.84 |
| 36415 |
Collection of venous blood by venipuncture |
1,217 |
996 |
$10.32 |
| 90633 |
|
517 |
484 |
$5.00 |
| 97803 |
|
4,194 |
3,694 |
$0.05 |
| 1126F |
|
11,591 |
9,554 |
$0.01 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
5,445 |
4,588 |
$0.00 |
| 3044F |
|
1,607 |
1,403 |
$0.00 |
| 1220F |
|
117 |
116 |
$0.00 |
| 3008F |
|
16,027 |
13,233 |
$0.00 |
| 3048F |
|
1,066 |
878 |
$0.00 |
| 3017F |
|
654 |
563 |
$0.00 |
| 1125F |
|
1,431 |
1,231 |
$0.00 |
| 90744 |
|
251 |
224 |
$0.00 |
| 90647 |
|
26 |
24 |
$0.00 |
| 1036F |
|
7,809 |
6,449 |
$0.00 |
| 3080F |
|
463 |
340 |
$0.00 |
| 1170F |
|
194 |
174 |
$0.00 |
| 1035F |
|
480 |
418 |
$0.00 |
| 1034F |
|
889 |
732 |
$0.00 |
| 3075F |
|
1,367 |
1,165 |
$0.00 |
| 3079F |
|
2,627 |
2,067 |
$0.00 |
| 90716 |
|
96 |
90 |
$0.00 |
| 90696 |
|
27 |
24 |
$0.00 |
| 90656 |
|
32 |
32 |
$0.00 |
| 90686 |
|
140 |
95 |
$0.00 |
| 2001F |
|
292 |
286 |
$0.00 |
| 1101F |
|
52 |
52 |
$0.00 |
| 2000F |
|
182 |
179 |
$0.00 |
| 3061F |
|
172 |
135 |
$0.00 |
| 90697 |
|
25 |
25 |
$0.00 |
| 90698 |
|
617 |
523 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
138 |
107 |
$0.00 |
| 3049F |
|
290 |
242 |
$0.00 |
| 1000F |
|
95 |
94 |
$0.00 |
| 4010F |
|
44 |
26 |
$0.00 |
| 90651 |
|
79 |
73 |
$0.00 |
| 96127 |
|
24 |
13 |
$0.00 |
| 90677 |
|
46 |
46 |
$0.00 |
| 3072F |
|
22 |
12 |
$0.00 |
| 96160 |
|
378 |
330 |
$0.00 |
| 1160F |
|
11,185 |
8,931 |
$0.00 |
| 3078F |
|
8,935 |
7,186 |
$0.00 |
| 3725F |
|
9,201 |
7,342 |
$0.00 |
| 3050F |
|
86 |
66 |
$0.00 |
| 3288F |
|
5,875 |
4,698 |
$0.00 |
| 1159F |
|
11,591 |
9,100 |
$0.00 |
| 1090F |
|
347 |
288 |
$0.00 |
| 90671 |
|
332 |
324 |
$0.00 |
| 90681 |
|
34 |
34 |
$0.00 |
| 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 |
167 |
133 |
$0.00 |
| 91300 |
|
56 |
29 |
$0.00 |
| 3077F |
|
1,004 |
740 |
$0.00 |
| 90670 |
|
774 |
636 |
$0.00 |
| 90734 |
|
28 |
28 |
$0.00 |
| 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 |
19 |
16 |
$0.00 |
| 90707 |
|
42 |
39 |
$0.00 |
| 2028F |
|
211 |
160 |
$0.00 |
| 90461 |
|
22 |
22 |
$0.00 |
| 90710 |
|
32 |
29 |
$0.00 |
| 90715 |
|
28 |
25 |
$0.00 |
| 99201 |
|
19 |
16 |
$0.00 |