| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,341 |
4,808 |
$777K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,939 |
1,795 |
$268K |
| 90832 |
Psychotherapy, 30 minutes with patient |
435 |
364 |
$72K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
333 |
319 |
$53K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
397 |
360 |
$43K |
| D1120 |
Prophylaxis - child |
206 |
206 |
$35K |
| D1206 |
Topical application of fluoride varnish |
603 |
599 |
$34K |
| 99384 |
|
71 |
71 |
$13K |
| 99383 |
|
69 |
67 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
54 |
52 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
46 |
46 |
$7K |
| 99382 |
|
38 |
38 |
$7K |
| D1110 |
Prophylaxis - adult |
47 |
47 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
27 |
$4K |
| 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 |
1,082 |
902 |
$4K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
15 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
15 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
253 |
250 |
$2K |
| 99385 |
|
14 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
575 |
147 |
$613.59 |
| D1351 |
Sealant - per tooth |
233 |
57 |
$564.45 |
| D1354 |
|
44 |
44 |
$376.30 |
| 92015 |
Determination of refractive state |
115 |
110 |
$220.50 |
| 81025 |
|
425 |
382 |
$196.11 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
19 |
16 |
$14.16 |
| 81003 |
|
1,533 |
1,341 |
$3.05 |
| 90686 |
|
234 |
218 |
$0.02 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
745 |
716 |
$0.02 |
| 90651 |
|
104 |
103 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
15 |
14 |
$0.00 |
| 90620 |
|
13 |
13 |
$0.00 |
| 90461 |
|
392 |
377 |
$0.00 |
| 90715 |
|
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
37 |
37 |
$0.00 |
| 90734 |
|
38 |
38 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |
| 82948 |
|
32 |
30 |
$0.00 |