| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
6,888 |
6,545 |
$7K |
| D1206 |
Topical application of fluoride varnish |
5,213 |
5,105 |
$994.50 |
| 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 |
19,680 |
15,441 |
$418.91 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
36,776 |
32,424 |
$111.39 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
2,007 |
1,866 |
$68.21 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
61,741 |
51,524 |
$47.52 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
3,081 |
2,269 |
$18.88 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,477 |
1,428 |
$8.45 |
| 81003 |
|
717 |
682 |
$1.78 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,152 |
2,000 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,676 |
1,992 |
$0.00 |
| 98968 |
|
5,512 |
3,566 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,775 |
3,467 |
$0.00 |
| D1110 |
Prophylaxis - adult |
4,565 |
4,471 |
$0.00 |
| D0330 |
Panoramic radiographic image |
2,248 |
2,201 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,917 |
5,657 |
$0.00 |
| 99442 |
|
3,614 |
3,293 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
5,887 |
5,632 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,160 |
3,098 |
$0.00 |
| 81025 |
|
267 |
244 |
$0.00 |
| D4910 |
|
1,106 |
1,089 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
1,486 |
1,319 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,973 |
1,491 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
250 |
213 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,959 |
1,885 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,965 |
1,809 |
$0.00 |
| 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 |
1,673 |
1,039 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
1,530 |
695 |
$0.00 |
| D0270 |
|
3,707 |
3,603 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,007 |
970 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
157 |
147 |
$0.00 |
| 80305 |
|
1,300 |
959 |
$0.00 |
| 98926 |
|
1,314 |
1,154 |
$0.00 |
| 81002 |
|
376 |
356 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
653 |
608 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
117 |
113 |
$0.00 |
| D2394 |
|
55 |
50 |
$0.00 |
| D4341 |
|
447 |
315 |
$0.00 |
| D1999 |
|
277 |
249 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
22 |
20 |
$0.00 |
| 98927 |
|
102 |
89 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
39 |
36 |
$0.00 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
39 |
38 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
268 |
254 |
$0.00 |
| 17110 |
|
16 |
15 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
26 |
25 |
$0.00 |
| 99382 |
|
15 |
13 |
$0.00 |
| D2332 |
|
16 |
13 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
27 |
27 |
$0.00 |
| 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 |
13 |
12 |
$0.00 |
| D2940 |
|
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,620 |
4,516 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
3,522 |
3,447 |
$0.00 |
| 99441 |
|
859 |
790 |
$0.00 |
| D2330 |
|
434 |
322 |
$0.00 |
| 99443 |
|
2,274 |
2,049 |
$0.00 |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
639 |
456 |
$0.00 |
| D2331 |
|
771 |
556 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
5,486 |
3,890 |
$0.00 |
| D4342 |
|
237 |
149 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,088 |
1,019 |
$0.00 |
| 99381 |
|
27 |
26 |
$0.00 |
| D1351 |
Sealant - per tooth |
160 |
58 |
$0.00 |
| 98967 |
|
437 |
381 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,560 |
2,511 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
6,727 |
3,359 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,730 |
2,989 |
$0.00 |
| 36416 |
|
397 |
385 |
$0.00 |
| D3120 |
|
142 |
138 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
487 |
457 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
814 |
763 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
251 |
241 |
$0.00 |
| 98925 |
|
163 |
139 |
$0.00 |
| 96127 |
|
1,018 |
725 |
$0.00 |
| 90688 |
|
459 |
441 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
22 |
13 |
$0.00 |
| D2335 |
|
48 |
38 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
81 |
$0.00 |
| 99383 |
|
77 |
71 |
$0.00 |
| 90839 |
|
13 |
12 |
$0.00 |