| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,212 |
15,569 |
$904K |
| D0120 |
Periodic oral evaluation - established patient |
4,135 |
4,126 |
$130K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,382 |
1,325 |
$115K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,197 |
2,619 |
$111K |
| D1110 |
Prophylaxis - adult |
1,741 |
1,736 |
$110K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,001 |
944 |
$86K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,032 |
1,007 |
$80K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
452 |
439 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
904 |
901 |
$34K |
| D1351 |
Sealant - per tooth |
3,730 |
729 |
$33K |
| D1330 |
|
5,139 |
5,123 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
429 |
374 |
$23K |
| 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 |
4,844 |
3,616 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
303 |
$14K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
331 |
300 |
$13K |
| D1206 |
Topical application of fluoride varnish |
4,622 |
4,611 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,989 |
1,986 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
745 |
732 |
$9K |
| D1120 |
Prophylaxis - child |
2,197 |
2,193 |
$7K |
| D1354 |
|
964 |
255 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,846 |
1,839 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,074 |
1,001 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,198 |
2,048 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
69 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
24 |
24 |
$2K |
| 99188 |
|
231 |
222 |
$2K |
| 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 |
2,609 |
1,898 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
148 |
148 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
67 |
67 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,437 |
1,405 |
$1K |
| 82962 |
|
1,189 |
932 |
$1K |
| 99381 |
|
14 |
14 |
$1K |
| 99385 |
|
13 |
12 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
112 |
108 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
12 |
$1K |
| 90474 |
|
219 |
204 |
$905.00 |
| 85018 |
|
829 |
809 |
$872.28 |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
242 |
$634.63 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
15 |
$501.64 |
| D1999 |
|
12 |
12 |
$480.00 |
| 81002 |
|
417 |
375 |
$461.69 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
86 |
$342.00 |
| 90686 |
|
1,915 |
1,873 |
$232.40 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
24 |
14 |
$215.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
18 |
12 |
$153.99 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
18 |
12 |
$38.90 |
| 36415 |
Collection of venous blood by venipuncture |
2,374 |
2,139 |
$11.50 |
| 90633 |
|
494 |
473 |
$11.00 |
| 90651 |
|
307 |
301 |
$7.03 |
| 90670 |
|
447 |
421 |
$5.50 |
| 90744 |
|
106 |
103 |
$5.00 |
| 97802 |
|
375 |
271 |
$0.03 |
| 97803 |
|
4,866 |
4,458 |
$0.01 |
| 1160F |
|
7,018 |
5,847 |
$0.00 |
| 3725F |
|
6,869 |
5,676 |
$0.00 |
| 3288F |
|
1,998 |
1,719 |
$0.00 |
| 3078F |
|
7,087 |
6,259 |
$0.00 |
| 1159F |
|
7,050 |
5,877 |
$0.00 |
| 90671 |
|
351 |
341 |
$0.00 |
| 3077F |
|
135 |
109 |
$0.00 |
| 90734 |
|
14 |
12 |
$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 |
49 |
39 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| 90707 |
|
31 |
29 |
$0.00 |
| 90710 |
|
26 |
26 |
$0.00 |
| 90715 |
|
13 |
13 |
$0.00 |
| 90681 |
|
18 |
15 |
$0.00 |
| 90700 |
|
13 |
13 |
$0.00 |
| 3075F |
|
645 |
587 |
$0.00 |
| 3079F |
|
1,141 |
941 |
$0.00 |
| 3008F |
|
15,821 |
12,743 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
5,522 |
4,862 |
$0.00 |
| 1126F |
|
9,895 |
8,406 |
$0.00 |
| 4000F |
|
131 |
131 |
$0.00 |
| 3074F |
|
7,467 |
6,783 |
$0.00 |
| 1036F |
|
6,181 |
5,213 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
12 |
$0.00 |
| 1125F |
|
336 |
317 |
$0.00 |
| 1101F |
|
47 |
46 |
$0.00 |
| 90698 |
|
196 |
183 |
$0.00 |
| 2000F |
|
253 |
250 |
$0.00 |
| 1035F |
|
461 |
401 |
$0.00 |
| 96127 |
|
457 |
391 |
$0.00 |
| 1220F |
|
166 |
161 |
$0.00 |
| 90680 |
|
257 |
239 |
$0.00 |
| 90697 |
|
270 |
264 |
$0.00 |
| 90716 |
|
64 |
62 |
$0.00 |
| 90619 |
|
63 |
63 |
$0.00 |
| 2001F |
|
427 |
398 |
$0.00 |
| 90656 |
|
368 |
360 |
$0.00 |
| D0240 |
|
27 |
27 |
$0.00 |
| 1034F |
|
398 |
339 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
48 |
38 |
$0.00 |
| 1000F |
|
94 |
92 |
$0.00 |
| 91305 |
|
19 |
15 |
$0.00 |
| 90688 |
|
17 |
13 |
$0.00 |