| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
54,464 |
43,213 |
$11.69M |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,944 |
1,268 |
$98K |
| 0011A |
|
1,837 |
1,759 |
$58K |
| 0012A |
|
1,538 |
1,480 |
$55K |
| 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 |
792 |
650 |
$38K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,972 |
8,412 |
$15K |
| 0013A |
|
326 |
321 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,006 |
3,358 |
$5K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
56 |
56 |
$1K |
| 0064A |
|
32 |
32 |
$880.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
702 |
621 |
$544.20 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
76 |
76 |
$478.24 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
331 |
250 |
$162.00 |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
527 |
$108.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,520 |
1,495 |
$48.00 |
| D4346 |
|
78 |
74 |
$43.20 |
| D1110 |
Prophylaxis - adult |
1,318 |
1,294 |
$40.80 |
| 99173 |
|
527 |
500 |
$40.14 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,424 |
1,406 |
$24.00 |
| D0140 |
Limited oral evaluation - problem focused |
494 |
478 |
$24.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,184 |
1,155 |
$19.20 |
| 92551 |
|
175 |
165 |
$12.84 |
| D1330 |
|
998 |
976 |
$5.00 |
| 91301 |
|
1,477 |
1,369 |
$4.18 |
| 96127 |
|
1,680 |
1,542 |
$0.55 |
| 3008F |
|
1,112 |
979 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
696 |
525 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
438 |
375 |
$0.00 |
| D1351 |
Sealant - per tooth |
46 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
592 |
580 |
$0.00 |
| 3074F |
|
311 |
273 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
61 |
60 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
178 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
89 |
86 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
27 |
26 |
$0.00 |
| 90688 |
|
86 |
82 |
$0.00 |
| 97802 |
|
41 |
31 |
$0.00 |
| 3079F |
|
56 |
53 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| 3080F |
|
23 |
19 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$0.00 |
| D5899 |
|
232 |
197 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
24 |
$0.00 |
| 99385 |
|
14 |
14 |
$0.00 |
| D0330 |
Panoramic radiographic image |
524 |
523 |
$0.00 |
| D1120 |
Prophylaxis - child |
330 |
326 |
$0.00 |
| D0270 |
|
83 |
81 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,229 |
1,215 |
$0.00 |
| 3078F |
|
267 |
243 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
57 |
53 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
68 |
63 |
$0.00 |
| 3077F |
|
45 |
36 |
$0.00 |
| 97803 |
|
43 |
42 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$0.00 |
| 92550 |
|
14 |
14 |
$0.00 |
| D9110 |
|
28 |
26 |
$0.00 |
| D9430 |
|
40 |
38 |
$0.00 |
| 82948 |
|
14 |
13 |
$0.00 |