| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,660 |
21,701 |
$637K |
| H1000 |
Prenatal care, at-risk assessment |
8,482 |
4,842 |
$349K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,345 |
1,948 |
$131K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,649 |
1,454 |
$95K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,437 |
1,098 |
$82K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,319 |
3,147 |
$73K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
808 |
762 |
$52K |
| 76801 |
|
1,230 |
674 |
$36K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,161 |
1,002 |
$35K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
535 |
453 |
$34K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
432 |
368 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,791 |
1,598 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
888 |
812 |
$24K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,675 |
1,894 |
$23K |
| D1110 |
Prophylaxis - adult |
778 |
771 |
$20K |
| D1330 |
|
2,346 |
2,264 |
$18K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
412 |
250 |
$15K |
| 90834 |
Psychotherapy, 45 minutes with patient |
336 |
246 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,312 |
1,204 |
$13K |
| 59430 |
|
388 |
275 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
809 |
673 |
$12K |
| 99381 |
|
191 |
146 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
348 |
266 |
$11K |
| 90671 |
|
406 |
382 |
$11K |
| 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 |
2,851 |
2,012 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,285 |
2,103 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,868 |
1,232 |
$8K |
| D0330 |
Panoramic radiographic image |
459 |
445 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,489 |
1,446 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,232 |
1,122 |
$8K |
| 81025 |
|
4,791 |
3,692 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
109 |
$6K |
| 99401 |
|
425 |
356 |
$6K |
| 90670 |
|
617 |
469 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
5,825 |
4,825 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
281 |
122 |
$4K |
| 91301 |
|
163 |
133 |
$4K |
| 90461 |
|
2,009 |
989 |
$4K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
279 |
158 |
$4K |
| 99385 |
|
84 |
58 |
$3K |
| D1351 |
Sealant - per tooth |
203 |
63 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
97 |
$3K |
| D1120 |
Prophylaxis - child |
220 |
218 |
$3K |
| 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 |
2,420 |
1,690 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,507 |
2,229 |
$3K |
| D0274 |
Bitewings - four radiographic images |
525 |
483 |
$3K |
| 99383 |
|
28 |
28 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
458 |
184 |
$2K |
| D0191 |
|
894 |
883 |
$2K |
| 81002 |
|
3,363 |
2,174 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
930 |
695 |
$2K |
| 3074F |
|
18,225 |
14,956 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
33 |
29 |
$1K |
| 82962 |
|
3,713 |
2,822 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
47 |
39 |
$1K |
| 0012A |
|
110 |
89 |
$1K |
| D0190 |
|
230 |
214 |
$998.42 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$990.79 |
| 83655 |
|
307 |
291 |
$962.43 |
| 90710 |
|
199 |
186 |
$887.60 |
| 99384 |
|
16 |
14 |
$854.76 |
| D0603 |
|
1,510 |
1,358 |
$804.95 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$725.53 |
| D9995 |
|
93 |
88 |
$671.10 |
| D0272 |
Bitewings - two radiographic images |
168 |
168 |
$521.84 |
| 3075F |
|
2,523 |
1,992 |
$459.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
103 |
$446.19 |
| 90651 |
|
332 |
246 |
$306.16 |
| 90715 |
|
65 |
60 |
$304.18 |
| 3078F |
|
15,549 |
12,308 |
$299.23 |
| D0602 |
|
244 |
230 |
$289.00 |
| 0011A |
|
75 |
65 |
$284.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
54 |
49 |
$282.15 |
| 90697 |
|
344 |
308 |
$269.82 |
| 85018 |
|
401 |
378 |
$261.33 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
14 |
13 |
$258.18 |
| 90647 |
|
134 |
125 |
$242.00 |
| 3079F |
|
7,086 |
5,470 |
$240.42 |
| 90686 |
|
24 |
24 |
$217.88 |
| 90633 |
|
244 |
222 |
$179.80 |
| 90619 |
|
81 |
79 |
$153.18 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
48 |
33 |
$151.65 |
| D0270 |
|
110 |
91 |
$149.07 |
| 92587 |
|
53 |
52 |
$133.96 |
| 90723 |
|
46 |
42 |
$133.00 |
| D0601 |
|
327 |
324 |
$127.94 |
| 90474 |
|
62 |
52 |
$117.00 |
| 90681 |
|
193 |
182 |
$75.00 |
| 1159F |
|
28,821 |
23,613 |
$62.45 |
| 2001F |
|
34,541 |
27,498 |
$59.38 |
| 90734 |
|
14 |
14 |
$54.60 |
| 81003 |
|
3,599 |
2,053 |
$54.37 |
| 2010F |
|
13,283 |
11,093 |
$39.70 |
| 1160F |
|
28,880 |
23,642 |
$35.27 |
| 90696 |
|
12 |
12 |
$15.60 |
| 90674 |
|
13 |
13 |
$10.00 |
| 36416 |
|
1,164 |
933 |
$4.72 |
| 1036F |
|
2,782 |
2,446 |
$4.21 |
| 96127 |
|
1,346 |
1,117 |
$1.68 |
| 3008F |
|
27,494 |
22,180 |
$1.02 |
| 4010F |
|
999 |
793 |
$0.01 |
| 1220F |
|
14,532 |
12,433 |
$0.00 |
| 2000F |
|
27,814 |
21,657 |
$0.00 |
| 3044F |
|
1,628 |
1,429 |
$0.00 |
| 1000F |
|
17,762 |
15,058 |
$0.00 |
| 4000F |
|
4,534 |
4,095 |
$0.00 |
| D1310 |
|
404 |
396 |
$0.00 |
| 1126F |
|
3,272 |
2,822 |
$0.00 |
| 1055F |
|
873 |
745 |
$0.00 |
| 4060F |
|
72 |
45 |
$0.00 |
| 3080F |
|
420 |
274 |
$0.00 |
| 4050F |
|
28 |
27 |
$0.00 |
| 92551 |
|
731 |
604 |
$0.00 |
| 1034F |
|
170 |
156 |
$0.00 |
| 1125F |
|
1,000 |
923 |
$0.00 |
| 99000 |
|
405 |
265 |
$0.00 |
| D4999 |
|
324 |
321 |
$0.00 |
| 3351F |
|
805 |
779 |
$0.00 |
| 0501F |
|
229 |
178 |
$0.00 |
| 1157F |
|
477 |
202 |
$0.00 |
| 4037F |
|
30 |
28 |
$0.00 |
| 3353F |
|
78 |
72 |
$0.00 |
| 1111F |
|
12 |
12 |
$0.00 |
| 90677 |
|
26 |
26 |
$0.00 |
| 87428 |
|
12 |
12 |
$0.00 |
| 99173 |
|
1,239 |
1,010 |
$0.00 |
| 3077F |
|
1,252 |
882 |
$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 |
53 |
37 |
$0.00 |
| 99177 |
|
614 |
584 |
$0.00 |
| 4013F |
|
31 |
30 |
$0.00 |
| 4025F |
|
14 |
12 |
$0.00 |
| 0502F |
|
485 |
325 |
$0.00 |
| 2028F |
|
261 |
246 |
$0.00 |
| 3210F |
|
16 |
15 |
$0.00 |
| 4035F |
|
17 |
17 |
$0.00 |
| 90756 |
|
13 |
12 |
$0.00 |