| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
5,609 |
4,328 |
$1.93M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,761 |
6,034 |
$1.40M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,588 |
3,374 |
$673K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,219 |
1,187 |
$56K |
| 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 |
1,247 |
1,099 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
119 |
$19K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
63 |
63 |
$15K |
| D0330 |
Panoramic radiographic image |
518 |
461 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
58 |
58 |
$12K |
| D1110 |
Prophylaxis - adult |
420 |
358 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,142 |
1,066 |
$12K |
| D0274 |
Bitewings - four radiographic images |
460 |
402 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
535 |
493 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,713 |
1,572 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
25 |
$6K |
| D1206 |
Topical application of fluoride varnish |
486 |
439 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
194 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$3K |
| D4910 |
|
40 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
667 |
613 |
$3K |
| 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 |
186 |
116 |
$2K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
133 |
91 |
$2K |
| 99000 |
|
1,261 |
1,046 |
$976.04 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
118 |
116 |
$745.62 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$372.00 |
| D0270 |
|
279 |
276 |
$31.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
216 |
208 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
149 |
134 |
$0.00 |
| 90686 |
|
416 |
402 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
81 |
81 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
13 |
13 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
42 |
42 |
$0.00 |
| 90656 |
|
21 |
21 |
$0.00 |
| Q2039 |
Influenza virus vaccine, not otherwise specified |
13 |
13 |
$0.00 |
| 82947 |
|
40 |
38 |
$0.00 |
| D0190 |
|
14 |
14 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
64 |
60 |
$0.00 |
| 81002 |
|
210 |
163 |
$0.00 |
| 99173 |
|
37 |
37 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25 |
25 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$0.00 |