| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
7,842 |
6,489 |
$496K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
654 |
536 |
$88K |
| D1110 |
Prophylaxis - adult |
1,202 |
1,197 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,848 |
1,843 |
$77K |
| 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 |
1,065 |
642 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
606 |
474 |
$59K |
| 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 |
690 |
660 |
$52K |
| D1120 |
Prophylaxis - child |
1,264 |
1,264 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
384 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
942 |
$22K |
| D0274 |
Bitewings - four radiographic images |
804 |
802 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
220 |
215 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,161 |
1,152 |
$15K |
| D1206 |
Topical application of fluoride varnish |
547 |
547 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,220 |
3,905 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
992 |
615 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,324 |
1,265 |
$7K |
| D1351 |
Sealant - per tooth |
236 |
67 |
$6K |
| D0272 |
Bitewings - two radiographic images |
230 |
230 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,432 |
1,394 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
93 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
339 |
263 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
16 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
1,996 |
1,851 |
$2K |
| 82962 |
|
1,821 |
1,713 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
223 |
220 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
553 |
539 |
$1K |
| 90756 |
|
249 |
245 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
238 |
180 |
$1K |
| 86703 |
|
375 |
357 |
$670.00 |
| 93000 |
|
141 |
136 |
$489.77 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
42 |
42 |
$321.56 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
443 |
418 |
$320.31 |
| 81025 |
|
185 |
172 |
$253.76 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
69 |
63 |
$245.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
128 |
115 |
$210.34 |
| 81000 |
|
233 |
219 |
$187.83 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
31 |
30 |
$184.24 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
68 |
63 |
$180.41 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
35 |
32 |
$162.68 |
| 99406 |
|
41 |
39 |
$97.44 |
| 90674 |
|
17 |
15 |
$93.05 |
| 90658 |
|
28 |
28 |
$83.44 |
| 69210 |
|
12 |
12 |
$79.65 |
| 86580 |
|
28 |
28 |
$46.93 |
| 1034F |
|
1,139 |
1,026 |
$0.00 |
| 88142 |
|
55 |
55 |
$0.00 |
| 1036F |
|
1,431 |
1,336 |
$0.00 |
| 84153 |
|
82 |
80 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
923 |
902 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
190 |
186 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
364 |
360 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
663 |
648 |
$0.00 |
| 1000F |
|
2,545 |
2,305 |
$0.00 |
| 0001F |
|
1,843 |
1,715 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
57 |
57 |
$0.00 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
176 |
175 |
$0.00 |
| 87088 |
|
13 |
13 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
13 |
13 |
$0.00 |
| 86592 |
|
113 |
110 |
$0.00 |
| 99386 |
|
12 |
12 |
$0.00 |
| 94760 |
|
13 |
13 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| 57410 |
|
14 |
14 |
$0.00 |
| 80061 |
Lipid panel |
561 |
552 |
$0.00 |
| 82570 |
|
55 |
55 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
177 |
171 |
$0.00 |
| 99173 |
|
99 |
98 |
$0.00 |
| 97803 |
|
25 |
25 |
$0.00 |
| 80074 |
|
212 |
202 |
$0.00 |
| 87799 |
|
145 |
143 |
$0.00 |
| 4013F |
|
13 |
13 |
$0.00 |
| 99401 |
|
92 |
91 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
15 |
12 |
$0.00 |