| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,038 |
13,262 |
$834K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,225 |
4,313 |
$193K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
519 |
492 |
$52K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
560 |
529 |
$52K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
484 |
451 |
$44K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
343 |
326 |
$34K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
210 |
201 |
$14K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
128 |
121 |
$13K |
| D0330 |
Panoramic radiographic image |
306 |
293 |
$12K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,489 |
1,372 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,622 |
2,423 |
$6K |
| D1206 |
Topical application of fluoride varnish |
548 |
528 |
$5K |
| D1354 |
|
671 |
124 |
$5K |
| D1120 |
Prophylaxis - child |
106 |
105 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
87 |
53 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
404 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
368 |
313 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
664 |
590 |
$2K |
| 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 |
1,856 |
1,351 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
178 |
175 |
$858.85 |
| D0191 |
|
295 |
292 |
$837.11 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$799.74 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
234 |
202 |
$621.30 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
259 |
232 |
$494.38 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$493.10 |
| 0012A |
|
18 |
13 |
$267.10 |
| 90686 |
|
572 |
535 |
$232.42 |
| 1159F |
|
1,809 |
1,592 |
$208.35 |
| D0220 |
Intraoral - periapical first radiographic image |
465 |
439 |
$190.26 |
| 81003 |
|
444 |
392 |
$171.18 |
| D1330 |
|
270 |
265 |
$169.96 |
| 81025 |
|
164 |
121 |
$169.77 |
| 0011A |
|
20 |
12 |
$152.46 |
| D0602 |
|
209 |
191 |
$140.00 |
| 90723 |
|
64 |
58 |
$135.14 |
| 3077F |
|
752 |
623 |
$120.00 |
| 3008F |
|
5,305 |
4,647 |
$120.00 |
| 3079F |
|
1,185 |
994 |
$120.00 |
| 1160F |
|
1,761 |
1,541 |
$118.73 |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
34 |
$61.27 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
42 |
40 |
$30.95 |
| 99173 |
|
1,093 |
1,007 |
$27.00 |
| 85018 |
|
88 |
84 |
$25.18 |
| 92551 |
|
1,107 |
1,019 |
$22.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,669 |
1,451 |
$6.11 |
| 1033F |
|
80 |
78 |
$0.00 |
| 3725F |
|
4,259 |
3,637 |
$0.00 |
| 1158F |
|
1,786 |
1,557 |
$0.00 |
| 90734 |
|
63 |
59 |
$0.00 |
| 90670 |
|
231 |
215 |
$0.00 |
| 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 |
97 |
77 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
19 |
16 |
$0.00 |
| 3078F |
|
1,024 |
883 |
$0.00 |
| 90681 |
|
64 |
59 |
$0.00 |
| 90648 |
|
85 |
75 |
$0.00 |
| 90633 |
|
239 |
211 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| 1032F |
|
32 |
32 |
$0.00 |
| 90710 |
|
15 |
15 |
$0.00 |
| 1036F |
|
1,277 |
1,131 |
$0.00 |
| 3074F |
|
1,471 |
1,289 |
$0.00 |
| 1125F |
|
152 |
139 |
$0.00 |
| 3080F |
|
395 |
349 |
$0.00 |
| 1126F |
|
342 |
305 |
$0.00 |
| 1034F |
|
219 |
200 |
$0.00 |
| 90651 |
|
123 |
116 |
$0.00 |
| 3075F |
|
320 |
304 |
$0.00 |
| D0603 |
|
14 |
14 |
$0.00 |
| 91301 |
|
32 |
25 |
$0.00 |
| 4000F |
|
80 |
66 |
$0.00 |
| 1111F |
|
18 |
18 |
$0.00 |