| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
31,901 |
26,574 |
$2.21M |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
13,126 |
7,243 |
$875K |
| D1110 |
Prophylaxis - adult |
9,178 |
9,100 |
$752K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,054 |
3,579 |
$594K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,274 |
3,540 |
$547K |
| D0140 |
Limited oral evaluation - problem focused |
5,391 |
5,227 |
$363K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,684 |
2,811 |
$345K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,361 |
5,277 |
$326K |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
2,900 |
2,881 |
$255K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,579 |
1,458 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
8,289 |
8,235 |
$217K |
| D1120 |
Prophylaxis - child |
5,225 |
5,204 |
$206K |
| D1206 |
Topical application of fluoride varnish |
6,607 |
6,577 |
$143K |
| D0210 |
Intraoral - complete series of radiographic images |
3,481 |
3,257 |
$118K |
| D0274 |
Bitewings - four radiographic images |
4,858 |
4,822 |
$95K |
| D2331 |
|
929 |
765 |
$94K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,718 |
9,112 |
$82K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,909 |
14,878 |
$77K |
| 90837 |
Psychotherapy, 53 minutes with patient |
4,485 |
2,595 |
$72K |
| D0330 |
Panoramic radiographic image |
2,197 |
2,176 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
7,375 |
7,203 |
$64K |
| D1351 |
Sealant - per tooth |
2,229 |
640 |
$61K |
| D2330 |
|
709 |
506 |
$47K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,682 |
2,561 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,392 |
3,634 |
$29K |
| D2335 |
|
171 |
143 |
$26K |
| D2332 |
|
196 |
159 |
$26K |
| D4910 |
|
373 |
373 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,048 |
1,045 |
$20K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,137 |
2,145 |
$18K |
| G0469 |
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new 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 mental health visit |
196 |
191 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
70 |
$13K |
| D4341 |
|
59 |
31 |
$8K |
| D0191 |
|
495 |
495 |
$7K |
| D2394 |
|
42 |
40 |
$7K |
| D0270 |
|
1,347 |
1,320 |
$7K |
| 90791 |
Psychiatric diagnostic evaluation |
419 |
411 |
$7K |
| D1354 |
|
251 |
183 |
$5K |
| 0012A |
|
143 |
143 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,427 |
3,364 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
736 |
732 |
$4K |
| 80305 |
|
2,147 |
1,993 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
351 |
351 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
93 |
91 |
$3K |
| 0011A |
|
114 |
113 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
218 |
218 |
$3K |
| 90674 |
|
831 |
826 |
$2K |
| 99000 |
|
392 |
384 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
329 |
328 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,885 |
1,880 |
$2K |
| 96152 |
|
820 |
569 |
$2K |
| 99406 |
|
1,165 |
1,117 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
669 |
621 |
$2K |
| 0064A |
|
40 |
40 |
$2K |
| 0001A |
|
40 |
38 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
3,332 |
3,188 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
864 |
836 |
$1K |
| 90686 |
|
722 |
718 |
$1K |
| 0002A |
|
34 |
34 |
$1K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
309 |
191 |
$1K |
| D2940 |
|
14 |
13 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
497 |
469 |
$552.80 |
| 90715 |
|
174 |
173 |
$543.79 |
| 90661 |
|
36 |
35 |
$515.90 |
| 0072A |
|
13 |
13 |
$492.05 |
| 99407 |
|
177 |
170 |
$458.25 |
| 90750 |
|
31 |
31 |
$445.20 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
309 |
171 |
$357.92 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
134 |
133 |
$294.96 |
| 0124A |
|
12 |
12 |
$263.64 |
| 96158 |
|
35 |
31 |
$234.07 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
200 |
199 |
$229.31 |
| 81025 |
|
182 |
172 |
$163.91 |
| 96150 |
|
29 |
28 |
$86.94 |
| 81003 |
|
434 |
418 |
$86.62 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
136 |
133 |
$85.18 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
58 |
57 |
$82.26 |
| 36416 |
|
2,215 |
2,184 |
$70.60 |
| 90632 |
|
29 |
29 |
$58.44 |
| 87428 |
|
12 |
12 |
$58.20 |
| 98966 |
|
14 |
14 |
$41.57 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
13 |
$9.20 |
| 81002 |
|
74 |
71 |
$9.06 |
| 82044 |
|
13 |
13 |
$5.16 |
| 85018 |
|
159 |
157 |
$2.43 |
| D1310 |
|
722 |
696 |
$0.00 |
| D0603 |
|
1,153 |
1,118 |
$0.00 |
| D1330 |
|
1,552 |
1,508 |
$0.00 |
| D1320 |
|
302 |
289 |
$0.00 |
| 91301 |
|
158 |
158 |
$0.00 |
| D0602 |
|
238 |
234 |
$0.00 |
| 81000 |
|
13 |
13 |
$0.00 |
| D0601 |
|
64 |
63 |
$0.00 |
| 80100 |
|
13 |
12 |
$0.00 |
| 91307 |
|
33 |
32 |
$0.00 |
| 99496 |
|
13 |
13 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
12 |
$0.00 |
| D0431 |
|
1,345 |
1,312 |
$0.00 |
| 99173 |
|
106 |
105 |
$0.00 |
| 91300 |
|
149 |
136 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$0.00 |
| 91312 |
|
12 |
12 |
$0.00 |