| 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 |
7,671 |
7,244 |
$488K |
| D1110 |
Prophylaxis - adult |
1,094 |
1,086 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
773 |
752 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
515 |
489 |
$61K |
| 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 |
769 |
754 |
$54K |
| D4355 |
|
180 |
173 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
136 |
130 |
$13K |
| D1120 |
Prophylaxis - child |
250 |
247 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,346 |
3,197 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
361 |
359 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,273 |
2,235 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
598 |
595 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,285 |
1,242 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
709 |
699 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
289 |
281 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
416 |
416 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
510 |
500 |
$3K |
| D1206 |
Topical application of fluoride varnish |
173 |
173 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,464 |
1,395 |
$3K |
| 81025 |
|
1,183 |
1,097 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
304 |
297 |
$3K |
| 83655 |
|
559 |
537 |
$2K |
| D0274 |
Bitewings - four radiographic images |
337 |
327 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
435 |
428 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
446 |
$2K |
| 99406 |
|
612 |
600 |
$2K |
| 92551 |
|
1,313 |
1,306 |
$1K |
| 81002 |
|
1,431 |
1,324 |
$1K |
| 99402 |
|
41 |
40 |
$850.08 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
114 |
113 |
$845.88 |
| 83037 |
|
221 |
219 |
$607.84 |
| 36415 |
Collection of venous blood by venipuncture |
590 |
582 |
$518.40 |
| D0191 |
|
41 |
40 |
$506.44 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
53 |
53 |
$439.25 |
| 81001 |
|
318 |
304 |
$347.54 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$300.00 |
| 90685 |
|
364 |
358 |
$239.98 |
| D0330 |
Panoramic radiographic image |
76 |
68 |
$232.00 |
| 96127 |
|
163 |
163 |
$178.80 |
| 90686 |
|
974 |
970 |
$133.23 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
17 |
16 |
$74.48 |
| 82948 |
|
269 |
261 |
$45.74 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
16 |
16 |
$42.00 |
| 85018 |
|
13 |
12 |
$10.00 |
| 90649 |
|
14 |
14 |
$0.02 |
| 90723 |
|
76 |
73 |
$0.00 |
| 94760 |
|
322 |
317 |
$0.00 |
| 90680 |
|
222 |
219 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
15 |
15 |
$0.00 |
| 90647 |
|
65 |
64 |
$0.00 |
| 90670 |
|
147 |
144 |
$0.00 |
| 90633 |
|
31 |
30 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 90734 |
|
15 |
15 |
$0.00 |