| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,932 |
9,731 |
$476K |
| H1000 |
Prenatal care, at-risk assessment |
1,886 |
1,615 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
4,666 |
4,220 |
$130K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,307 |
1,297 |
$88K |
| D1110 |
Prophylaxis - adult |
1,695 |
1,544 |
$83K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
966 |
913 |
$71K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
977 |
967 |
$58K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,523 |
1,325 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,161 |
855 |
$36K |
| D1351 |
Sealant - per tooth |
2,427 |
861 |
$25K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
420 |
416 |
$25K |
| 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 |
2,849 |
2,172 |
$18K |
| D1206 |
Topical application of fluoride varnish |
4,451 |
4,017 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
175 |
$9K |
| D1120 |
Prophylaxis - child |
2,770 |
2,492 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
181 |
162 |
$6K |
| 99188 |
|
758 |
749 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
189 |
$5K |
| D1330 |
|
5,246 |
4,749 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,198 |
1,078 |
$3K |
| 85018 |
|
3,186 |
3,148 |
$2K |
| D0274 |
Bitewings - four radiographic images |
943 |
865 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,218 |
1,208 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
469 |
425 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
14 |
$688.41 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
47 |
46 |
$437.36 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
24 |
$377.44 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
37 |
37 |
$350.00 |
| 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 |
1,782 |
1,277 |
$321.12 |
| D0220 |
Intraoral - periapical first radiographic image |
1,208 |
1,074 |
$316.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
806 |
707 |
$238.50 |
| 90688 |
|
48 |
43 |
$181.10 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$78.00 |
| 1159F |
|
9,007 |
7,497 |
$70.89 |
| 1036F |
|
5,851 |
4,617 |
$15.50 |
| 81002 |
|
31 |
27 |
$13.40 |
| 36415 |
Collection of venous blood by venipuncture |
272 |
264 |
$6.45 |
| 90680 |
|
330 |
327 |
$5.00 |
| 90698 |
|
357 |
354 |
$5.00 |
| 97803 |
|
5,747 |
5,220 |
$0.01 |
| 90656 |
|
148 |
148 |
$0.01 |
| 3288F |
|
518 |
457 |
$0.00 |
| 90670 |
|
419 |
412 |
$0.00 |
| 3725F |
|
5,709 |
4,535 |
$0.00 |
| 1160F |
|
8,998 |
7,489 |
$0.00 |
| 3078F |
|
11,542 |
9,145 |
$0.00 |
| 90671 |
|
183 |
182 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
27 |
26 |
$0.00 |
| 90461 |
|
15 |
15 |
$0.00 |
| 90633 |
|
41 |
40 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |
| 90734 |
|
49 |
49 |
$0.00 |
| D0191 |
|
18 |
18 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 1220F |
|
42 |
40 |
$0.00 |
| 1126F |
|
8,451 |
7,583 |
$0.00 |
| 3074F |
|
10,964 |
9,657 |
$0.00 |
| 3079F |
|
523 |
418 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
6,910 |
5,711 |
$0.00 |
| 1125F |
|
596 |
575 |
$0.00 |
| 3008F |
|
16,636 |
12,776 |
$0.00 |
| 90686 |
|
899 |
890 |
$0.00 |
| 2000F |
|
158 |
156 |
$0.00 |
| 3075F |
|
99 |
92 |
$0.00 |
| 90744 |
|
26 |
26 |
$0.00 |
| 1000F |
|
21 |
18 |
$0.00 |
| 90651 |
|
92 |
92 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| 90619 |
|
16 |
16 |
$0.00 |
| 2001F |
|
223 |
212 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
19 |
14 |
$0.00 |
| 90620 |
|
14 |
14 |
$0.00 |
| 90677 |
|
16 |
16 |
$0.00 |
| 91307 |
|
14 |
14 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
15 |
14 |
$0.00 |