| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,908 |
8,168 |
$905K |
| 99199 |
Unlisted special service, procedure or report |
141,785 |
55,175 |
$759K |
| D1120 |
Prophylaxis - child |
2,875 |
2,782 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,625 |
1,545 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,165 |
3,061 |
$49K |
| D1351 |
Sealant - per tooth |
1,694 |
350 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,148 |
1,130 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,990 |
1,914 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,153 |
1,117 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,545 |
1,395 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
61 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
33 |
$5K |
| 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 |
879 |
699 |
$4K |
| D1110 |
Prophylaxis - adult |
97 |
95 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
270 |
230 |
$2K |
| 0011A |
|
52 |
49 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
414 |
368 |
$2K |
| 0012A |
|
38 |
36 |
$2K |
| 99384 |
|
16 |
16 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
114 |
99 |
$1K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
44 |
25 |
$1K |
| 99383 |
|
14 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
43 |
40 |
$1K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
84 |
66 |
$999.74 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
76 |
67 |
$976.19 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$963.96 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
26 |
$863.75 |
| 82962 |
|
281 |
258 |
$705.03 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
29 |
27 |
$364.25 |
| 90656 |
|
13 |
12 |
$54.83 |
| 99173 |
|
226 |
212 |
$10.00 |
| 92551 |
|
157 |
150 |
$9.00 |
| 90658 |
|
75 |
66 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
53 |
27 |
$0.00 |
| 90734 |
|
17 |
16 |
$0.00 |
| 91301 |
|
106 |
99 |
$0.00 |
| D1330 |
|
1,359 |
1,320 |
$0.00 |
| D0603 |
|
315 |
309 |
$0.00 |
| D0601 |
|
196 |
183 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |
| 90651 |
|
16 |
15 |
$0.00 |