| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,360 |
21,250 |
$1.24M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,647 |
4,490 |
$371K |
| T1015 |
Clinic visit/encounter, all-inclusive |
20,781 |
16,253 |
$176K |
| 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 |
2,789 |
1,907 |
$65K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,830 |
1,415 |
$53K |
| D1120 |
Prophylaxis - child |
934 |
598 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,330 |
840 |
$29K |
| D1110 |
Prophylaxis - adult |
548 |
337 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,151 |
723 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
279 |
184 |
$22K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
254 |
220 |
$17K |
| 36415 |
Collection of venous blood by venipuncture |
5,030 |
4,254 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
337 |
192 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
187 |
$11K |
| D0274 |
Bitewings - four radiographic images |
351 |
212 |
$7K |
| D0330 |
Panoramic radiographic image |
366 |
233 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
28 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
171 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
29 |
$3K |
| 80305 |
|
463 |
354 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
406 |
346 |
$3K |
| D0272 |
Bitewings - two radiographic images |
201 |
121 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
446 |
355 |
$3K |
| 87430 |
|
168 |
136 |
$2K |
| 90686 |
|
132 |
117 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
12 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
261 |
239 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$954.60 |
| 92552 |
|
67 |
53 |
$927.50 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$875.22 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
90 |
67 |
$642.47 |
| 81003 |
|
279 |
237 |
$415.42 |
| 90656 |
|
12 |
12 |
$230.19 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
14 |
$193.17 |
| 97802 |
|
63 |
62 |
$102.52 |
| 99173 |
|
68 |
54 |
$57.45 |
| 97803 |
|
30 |
26 |
$22.00 |
| 82948 |
|
43 |
39 |
$1.50 |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
492 |
348 |
$0.00 |
| 99442 |
|
16 |
16 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
54 |
22 |
$0.00 |