| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,024 |
19,121 |
$3.23M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14,828 |
13,240 |
$2.25M |
| D1206 |
Topical application of fluoride varnish |
5,816 |
5,682 |
$519K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,812 |
1,684 |
$356K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,533 |
1,522 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
2,533 |
2,487 |
$260K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,464 |
1,101 |
$250K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,226 |
1,217 |
$241K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,561 |
1,292 |
$175K |
| D0140 |
Limited oral evaluation - problem focused |
1,182 |
1,134 |
$150K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
796 |
790 |
$150K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
778 |
736 |
$134K |
| D0272 |
Bitewings - two radiographic images |
1,500 |
1,476 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
661 |
645 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,162 |
558 |
$72K |
| D1351 |
Sealant - per tooth |
3,050 |
528 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
981 |
$60K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
386 |
368 |
$49K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
239 |
236 |
$44K |
| 99215 |
Prolong outpt/office vis |
268 |
255 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
184 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
194 |
$19K |
| D1110 |
Prophylaxis - adult |
934 |
908 |
$19K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,107 |
5,043 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
843 |
691 |
$16K |
| 90837 |
Psychotherapy, 53 minutes with patient |
85 |
66 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
74 |
72 |
$11K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
112 |
62 |
$10K |
| 90791 |
Psychiatric diagnostic evaluation |
53 |
52 |
$9K |
| 99383 |
|
54 |
54 |
$9K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
25 |
25 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,179 |
1,124 |
$7K |
| D1120 |
Prophylaxis - child |
1,763 |
1,733 |
$6K |
| 90686 |
|
1,768 |
1,751 |
$5K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,694 |
2,667 |
$4K |
| 99384 |
|
25 |
25 |
$4K |
| 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 |
2,386 |
1,950 |
$4K |
| 99382 |
|
13 |
13 |
$2K |
| G9148 |
National committee for quality assurance - level 1 medical home |
30 |
26 |
$2K |
| S0311 |
Comprehensive management and care coordination for advanced illness, per calendar month |
14 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
878 |
853 |
$1K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
15 |
15 |
$1K |
| 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 |
2,473 |
2,425 |
$1K |
| 90647 |
|
372 |
370 |
$896.40 |
| 90723 |
|
338 |
337 |
$725.19 |
| 90670 |
|
764 |
758 |
$720.02 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$717.12 |
| 90734 |
|
208 |
206 |
$537.84 |
| 90694 |
|
14 |
12 |
$146.98 |
| 91322 |
|
34 |
32 |
$128.00 |
| G0512 |
Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month |
131 |
126 |
$126.00 |
| 80053 |
Comprehensive metabolic panel |
15 |
15 |
$109.20 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
65 |
56 |
$15.66 |
| 36415 |
Collection of venous blood by venipuncture |
1,364 |
1,233 |
$11.49 |
| 3078F |
|
6,658 |
6,101 |
$0.10 |
| 90648 |
|
44 |
44 |
$0.01 |
| 90680 |
|
348 |
347 |
$0.01 |
| 99177 |
|
221 |
219 |
$0.00 |
| 3077F |
|
1,157 |
1,063 |
$0.00 |
| 3725F |
|
872 |
851 |
$0.00 |
| 90633 |
|
39 |
39 |
$0.00 |
| 1160F |
|
1,663 |
1,557 |
$0.00 |
| 90710 |
|
48 |
46 |
$0.00 |
| 90715 |
|
85 |
84 |
$0.00 |
| 4004F |
|
59 |
57 |
$0.00 |
| 4274F |
|
61 |
60 |
$0.00 |
| 0071A |
|
18 |
18 |
$0.00 |
| D0270 |
|
14 |
14 |
$0.00 |
| 1036F |
|
1,776 |
1,639 |
$0.00 |
| 90677 |
|
208 |
204 |
$0.00 |
| 3079F |
|
1,611 |
1,526 |
$0.00 |
| 3008F |
|
8,643 |
7,879 |
$0.00 |
| 90696 |
|
47 |
45 |
$0.00 |
| 3074F |
|
6,369 |
5,869 |
$0.00 |
| 3075F |
|
1,164 |
1,106 |
$0.00 |
| 3044F |
|
62 |
56 |
$0.00 |
| 3080F |
|
167 |
154 |
$0.00 |
| 90651 |
|
242 |
241 |
$0.00 |
| 90656 |
|
111 |
107 |
$0.00 |
| 90620 |
|
52 |
52 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
22 |
15 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
55 |
54 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
79 |
51 |
$0.00 |
| 90480 |
|
54 |
54 |
$0.00 |
| 0134A |
|
12 |
12 |
$0.00 |
| 0072A |
|
18 |
18 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |