| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
132,183 |
111,980 |
$22.14M |
| 0012A |
|
765 |
755 |
$26K |
| 0011A |
|
767 |
762 |
$22K |
| 0064A |
|
291 |
291 |
$10K |
| 3074F |
|
20,101 |
18,871 |
$8K |
| 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 |
2,414 |
2,073 |
$8K |
| 0001A |
|
216 |
215 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,928 |
20,254 |
$7K |
| 3079F |
|
8,703 |
8,307 |
$7K |
| 0002A |
|
193 |
193 |
$7K |
| 3078F |
|
16,419 |
15,502 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21,550 |
19,858 |
$5K |
| 3077F |
|
3,208 |
3,032 |
$5K |
| 3075F |
|
4,147 |
4,005 |
$4K |
| 0071A |
|
81 |
81 |
$3K |
| 3080F |
|
2,100 |
2,001 |
$2K |
| 0031A |
|
53 |
53 |
$2K |
| 0072A |
|
48 |
48 |
$2K |
| 0004A |
|
33 |
33 |
$1K |
| 0134A |
|
29 |
29 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,764 |
1,622 |
$971.69 |
| D0120 |
Periodic oral evaluation - established patient |
9,252 |
9,131 |
$583.20 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,142 |
1,670 |
$540.00 |
| D1206 |
Topical application of fluoride varnish |
9,620 |
9,498 |
$455.74 |
| 3044F |
|
524 |
515 |
$420.00 |
| D1110 |
Prophylaxis - adult |
6,679 |
6,582 |
$384.06 |
| 90688 |
|
574 |
473 |
$280.00 |
| D0274 |
Bitewings - four radiographic images |
5,928 |
5,845 |
$228.17 |
| 99177 |
|
2,692 |
2,533 |
$200.45 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,426 |
1,130 |
$150.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
788 |
567 |
$130.00 |
| D1120 |
Prophylaxis - child |
6,171 |
6,119 |
$109.62 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
287 |
279 |
$99.41 |
| D0330 |
Panoramic radiographic image |
3,223 |
3,175 |
$74.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
692 |
596 |
$65.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
234 |
207 |
$59.68 |
| D0140 |
Limited oral evaluation - problem focused |
347 |
342 |
$55.22 |
| D2330 |
|
491 |
359 |
$50.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,135 |
3,074 |
$46.09 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$38.86 |
| 90686 |
|
1,266 |
1,000 |
$37.30 |
| D9110 |
|
1,586 |
1,533 |
$30.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,808 |
1,780 |
$20.00 |
| 92551 |
|
1,146 |
1,099 |
$14.40 |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
4,267 |
1,779 |
$13.00 |
| 87210 |
|
882 |
805 |
$5.82 |
| D0272 |
Bitewings - two radiographic images |
1,767 |
1,755 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
19,006 |
17,758 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,519 |
1,489 |
$0.00 |
| D2331 |
|
511 |
408 |
$0.00 |
| D0603 |
|
699 |
693 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,582 |
1,137 |
$0.00 |
| D1351 |
Sealant - per tooth |
7,190 |
1,425 |
$0.00 |
| 1111F |
|
940 |
906 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
63 |
51 |
$0.00 |
| D9995 |
|
148 |
146 |
$0.00 |
| D0602 |
|
271 |
267 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
31 |
29 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
44 |
44 |
$0.00 |
| 90723 |
|
24 |
24 |
$0.00 |
| 90696 |
|
24 |
12 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
50 |
50 |
$0.00 |
| D2335 |
|
87 |
78 |
$0.00 |
| D0703 |
|
13 |
13 |
$0.00 |
| 98967 |
|
13 |
13 |
$0.00 |
| G9920 |
Screening performed and negative |
1,701 |
1,663 |
$0.00 |
| 98940 |
|
554 |
391 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,760 |
1,686 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,439 |
1,372 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
350 |
320 |
$0.00 |
| 95251 |
|
288 |
265 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
309 |
309 |
$0.00 |
| 81025 |
|
110 |
109 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
874 |
819 |
$0.00 |
| D1354 |
|
861 |
710 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
972 |
877 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
71 |
71 |
$0.00 |
| 90710 |
|
24 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
362 |
354 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
44 |
44 |
$0.00 |
| 81002 |
|
12 |
12 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
99 |
91 |
$0.00 |
| D2332 |
|
228 |
185 |
$0.00 |
| D0190 |
|
924 |
903 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
407 |
407 |
$0.00 |
| 90633 |
|
72 |
57 |
$0.00 |
| D2394 |
|
45 |
44 |
$0.00 |
| 90670 |
|
138 |
101 |
$0.00 |
| 90734 |
|
37 |
25 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
42 |
$0.00 |
| 99173 |
|
33 |
31 |
$0.00 |
| 99442 |
|
25 |
14 |
$0.00 |