| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,547 |
5,871 |
$600K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,872 |
6,240 |
$421K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
126 |
118 |
$22K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
477 |
450 |
$12K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
896 |
237 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
102 |
99 |
$11K |
| 99215 |
Prolong outpt/office vis |
60 |
55 |
$7K |
| 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 |
286 |
262 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
40 |
40 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
38 |
38 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
33 |
25 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
62 |
60 |
$2K |
| 99383 |
|
34 |
34 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
29 |
28 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
36 |
34 |
$537.32 |
| D1110 |
Prophylaxis - adult |
105 |
105 |
$487.60 |
| D0274 |
Bitewings - four radiographic images |
164 |
164 |
$272.32 |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$239.20 |
| D0120 |
Periodic oral evaluation - established patient |
190 |
189 |
$220.80 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$191.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
205 |
98 |
$103.04 |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
96 |
$93.84 |
| D1206 |
Topical application of fluoride varnish |
133 |
133 |
$42.32 |
| 36415 |
Collection of venous blood by venipuncture |
29 |
27 |
$16.20 |
| 2010F |
|
399 |
331 |
$0.00 |
| 2000F |
|
397 |
329 |
$0.00 |
| 1036F |
|
132 |
113 |
$0.00 |
| 3008F |
|
392 |
324 |
$0.00 |
| 4010F |
|
14 |
13 |
$0.00 |
| 2001F |
|
397 |
329 |
$0.00 |
| 1034F |
|
70 |
61 |
$0.00 |
| 3351F |
|
15 |
15 |
$0.00 |
| 1126F |
|
35 |
30 |
$0.00 |
| 1125F |
|
59 |
45 |
$0.00 |
| 3074F |
|
113 |
100 |
$0.00 |
| 3079F |
|
101 |
86 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
32 |
32 |
$0.00 |
| 3075F |
|
26 |
21 |
$0.00 |
| 3044F |
|
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
20 |
$0.00 |
| D1351 |
Sealant - per tooth |
31 |
12 |
$0.00 |
| 3078F |
|
105 |
91 |
$0.00 |
| 3077F |
|
67 |
55 |
$0.00 |
| 1159F |
|
207 |
177 |
$0.00 |
| 4004F |
|
14 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
16 |
$0.00 |
| D1120 |
Prophylaxis - child |
79 |
79 |
$0.00 |
| 1160F |
|
207 |
177 |
$0.00 |