| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,347 |
22,309 |
$1.31M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,570 |
12,612 |
$784K |
| D1120 |
Prophylaxis - child |
24,794 |
24,595 |
$710K |
| D1206 |
Topical application of fluoride varnish |
33,666 |
33,409 |
$596K |
| D0120 |
Periodic oral evaluation - established patient |
28,460 |
28,182 |
$484K |
| D1110 |
Prophylaxis - adult |
9,729 |
9,614 |
$371K |
| D1351 |
Sealant - per tooth |
4,533 |
1,670 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,699 |
1,400 |
$135K |
| D0272 |
Bitewings - two radiographic images |
5,810 |
5,759 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,255 |
1,034 |
$91K |
| 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 |
6,217 |
5,488 |
$90K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,119 |
1,104 |
$86K |
| D0330 |
Panoramic radiographic image |
1,760 |
1,649 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
4,155 |
3,650 |
$70K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
830 |
818 |
$66K |
| 92551 |
|
4,969 |
4,855 |
$49K |
| 90686 |
|
4,278 |
4,084 |
$46K |
| G9002 |
Coordinated care fee, maintenance rate |
421 |
399 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
5,553 |
4,873 |
$44K |
| D1354 |
|
2,285 |
778 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,121 |
2,085 |
$43K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
395 |
386 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
326 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
851 |
822 |
$28K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,720 |
1,666 |
$23K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
253 |
232 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
920 |
912 |
$16K |
| 90832 |
Psychotherapy, 30 minutes with patient |
225 |
202 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
632 |
565 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
414 |
$12K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
644 |
620 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
59 |
52 |
$8K |
| 99173 |
|
2,966 |
2,895 |
$7K |
| D0240 |
|
538 |
302 |
$7K |
| 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 |
902 |
887 |
$6K |
| 0002A |
|
133 |
133 |
$5K |
| 81025 |
|
684 |
657 |
$5K |
| 90791 |
Psychiatric diagnostic evaluation |
42 |
42 |
$5K |
| 0001A |
|
112 |
112 |
$4K |
| 99177 |
|
1,106 |
1,091 |
$4K |
| 90656 |
|
309 |
307 |
$4K |
| 0011A |
|
106 |
105 |
$3K |
| 90677 |
|
138 |
135 |
$3K |
| 0012A |
|
68 |
68 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
640 |
630 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
38 |
38 |
$2K |
| 81002 |
|
732 |
689 |
$2K |
| 0071A |
|
49 |
42 |
$2K |
| 82962 |
|
656 |
606 |
$2K |
| D9995 |
|
42 |
42 |
$1K |
| 90697 |
|
75 |
75 |
$1K |
| 0072A |
|
34 |
31 |
$1K |
| 90670 |
|
92 |
91 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
459 |
437 |
$1K |
| D1355 |
|
67 |
16 |
$1K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
132 |
117 |
$938.18 |
| D4910 |
|
12 |
12 |
$896.64 |
| 90651 |
|
40 |
40 |
$871.52 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
125 |
123 |
$821.16 |
| 90633 |
|
36 |
36 |
$565.00 |
| 0064A |
|
13 |
13 |
$520.00 |
| D2940 |
|
13 |
12 |
$498.64 |
| 90648 |
|
41 |
41 |
$451.00 |
| 0031A |
|
16 |
16 |
$425.85 |
| 90734 |
|
24 |
24 |
$408.18 |
| 90681 |
|
15 |
15 |
$397.38 |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
25 |
$381.17 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
24 |
12 |
$365.18 |
| D0270 |
|
67 |
66 |
$348.72 |
| 85018 |
|
101 |
100 |
$245.64 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$174.22 |
| 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 |
27 |
26 |
$26.64 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
13 |
12 |
$26.53 |
| G0008 |
Administration of influenza virus vaccine |
61 |
51 |
$19.19 |
| D9630 |
|
26 |
26 |
$0.00 |
| 91307 |
|
28 |
26 |
$0.00 |
| 91301 |
|
17 |
15 |
$0.00 |
| D1999 |
|
580 |
527 |
$0.00 |
| 91300 |
|
157 |
139 |
$0.00 |
| 86328 |
|
83 |
80 |
$0.00 |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
37 |
36 |
$0.00 |
| 3078F |
|
12 |
12 |
$0.00 |