| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,321 |
4,675 |
$837K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,954 |
2,594 |
$694K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,784 |
3,450 |
$627K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,719 |
1,334 |
$274K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,786 |
1,541 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
793 |
720 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,528 |
1,405 |
$61K |
| 90791 |
Psychiatric diagnostic evaluation |
243 |
239 |
$44K |
| D1110 |
Prophylaxis - adult |
359 |
305 |
$44K |
| D1120 |
Prophylaxis - child |
557 |
498 |
$37K |
| 90837 |
Psychotherapy, 53 minutes with patient |
230 |
132 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
200 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
755 |
641 |
$21K |
| 99215 |
Prolong outpt/office vis |
43 |
43 |
$7K |
| D0274 |
Bitewings - four radiographic images |
150 |
126 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
46 |
38 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
37 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
18 |
18 |
$4K |
| D0330 |
Panoramic radiographic image |
91 |
67 |
$3K |
| 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 |
1,242 |
1,031 |
$2K |
| 80053 |
Comprehensive metabolic panel |
107 |
94 |
$486.72 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
36 |
36 |
$208.68 |
| 87428 |
|
25 |
24 |
$30.94 |
| 82947 |
|
17 |
12 |
$10.38 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
47 |
39 |
$0.00 |
| D0190 |
|
285 |
284 |
$0.00 |
| D0180 |
|
18 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$0.00 |
| D0603 |
|
71 |
56 |
$0.00 |