| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14,537 |
11,758 |
$354K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,772 |
5,495 |
$194K |
| D1206 |
Topical application of fluoride varnish |
2,091 |
2,082 |
$44K |
| D1120 |
Prophylaxis - child |
1,347 |
1,343 |
$41K |
| D1354 |
|
4,743 |
831 |
$41K |
| D1351 |
Sealant - per tooth |
1,291 |
401 |
$23K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
309 |
277 |
$21K |
| D0330 |
Panoramic radiographic image |
305 |
291 |
$13K |
| D0191 |
|
2,027 |
2,020 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
536 |
480 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
93 |
93 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,584 |
2,285 |
$6K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,113 |
1,679 |
$5K |
| 82962 |
|
10,792 |
8,646 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
52 |
51 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
912 |
779 |
$3K |
| 90682 |
|
484 |
441 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
44 |
$2K |
| 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 |
9,431 |
7,440 |
$2K |
| D1110 |
Prophylaxis - adult |
52 |
47 |
$2K |
| 85018 |
|
4,413 |
3,686 |
$2K |
| D1330 |
|
1,651 |
1,638 |
$2K |
| 81003 |
|
3,414 |
2,888 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28 |
26 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
77 |
52 |
$1K |
| D0603 |
|
1,784 |
1,767 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
43 |
$1K |
| D0274 |
Bitewings - four radiographic images |
283 |
266 |
$879.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
410 |
286 |
$847.07 |
| D1355 |
|
245 |
69 |
$601.72 |
| D0602 |
|
413 |
412 |
$500.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$493.51 |
| 81025 |
|
265 |
237 |
$300.13 |
| 36415 |
Collection of venous blood by venipuncture |
2,805 |
2,377 |
$191.76 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
23 |
$115.31 |
| 3078F |
|
2,002 |
1,452 |
$53.43 |
| 3044F |
|
597 |
449 |
$40.00 |
| 90686 |
|
626 |
605 |
$36.39 |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
325 |
$4.00 |
| 3074F |
|
2,319 |
1,726 |
$0.00 |
| 1126F |
|
1,943 |
1,401 |
$0.00 |
| 92551 |
|
225 |
172 |
$0.00 |
| 1036F |
|
325 |
259 |
$0.00 |
| 3008F |
|
3,231 |
2,332 |
$0.00 |
| 3080F |
|
506 |
391 |
$0.00 |
| S9117 |
Back school, per visit |
32 |
32 |
$0.00 |
| 1125F |
|
646 |
473 |
$0.00 |
| 3075F |
|
82 |
58 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
327 |
267 |
$0.00 |
| 3079F |
|
364 |
287 |
$0.00 |
| 90674 |
|
106 |
102 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| 90688 |
|
14 |
12 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15 |
12 |
$0.00 |
| 3725F |
|
2,970 |
2,192 |
$0.00 |
| 90633 |
|
110 |
86 |
$0.00 |
| 1159F |
|
963 |
727 |
$0.00 |
| 3077F |
|
562 |
427 |
$0.00 |
| 99173 |
|
1,740 |
1,446 |
$0.00 |
| 1160F |
|
509 |
392 |
$0.00 |
| 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 |
548 |
469 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
356 |
284 |
$0.00 |
| 90670 |
|
30 |
27 |
$0.00 |
| 90662 |
|
44 |
36 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
15 |
14 |
$0.00 |
| 90734 |
|
12 |
12 |
$0.00 |
| 1033F |
|
35 |
27 |
$0.00 |