| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,432 |
1,925 |
$125K |
| 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 |
741 |
605 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
25 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
41 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
34 |
30 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
90 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$998.80 |
| D1110 |
Prophylaxis - adult |
33 |
33 |
$811.71 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
12 |
$733.43 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$541.71 |
| D1206 |
Topical application of fluoride varnish |
143 |
142 |
$530.81 |
| D1330 |
|
168 |
167 |
$382.60 |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
82 |
$350.97 |
| D1120 |
Prophylaxis - child |
45 |
44 |
$128.93 |
| 85018 |
|
105 |
99 |
$114.96 |
| 3074F |
|
1,171 |
980 |
$50.00 |
| 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 |
442 |
360 |
$42.57 |
| 97803 |
|
1,032 |
829 |
$32.73 |
| 82962 |
|
42 |
37 |
$9.03 |
| 90688 |
|
14 |
14 |
$7.74 |
| 1126F |
|
1,051 |
872 |
$0.00 |
| 3008F |
|
2,204 |
1,467 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,443 |
1,011 |
$0.00 |
| 1036F |
|
1,477 |
955 |
$0.00 |
| 90656 |
|
13 |
12 |
$0.00 |
| 3079F |
|
167 |
94 |
$0.00 |
| 2001F |
|
14 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$0.00 |
| 96127 |
|
178 |
147 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
15 |
14 |
$0.00 |
| 2000F |
|
15 |
14 |
$0.00 |
| 3078F |
|
1,265 |
881 |
$0.00 |
| 1160F |
|
956 |
783 |
$0.00 |
| 3288F |
|
441 |
354 |
$0.00 |
| 1159F |
|
954 |
782 |
$0.00 |
| 3725F |
|
1,435 |
952 |
$0.00 |