| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,226 |
8,008 |
$1.34M |
| D0999 |
Unspecified diagnostic procedure, by report |
2,481 |
2,082 |
$675K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,105 |
3,540 |
$368K |
| 99382 |
|
146 |
141 |
$26K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
98 |
96 |
$21K |
| 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 |
936 |
734 |
$19K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
611 |
596 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
82 |
82 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
91 |
87 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
83 |
82 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
154 |
$4K |
| 90686 |
|
81 |
77 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
26 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
702 |
202 |
$3K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D1110 |
Prophylaxis - adult |
210 |
208 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
12 |
$2K |
| 99000 |
|
1,002 |
946 |
$2K |
| 90688 |
|
14 |
14 |
$2K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
80 |
56 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
201 |
199 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
121 |
117 |
$816.16 |
| 36415 |
Collection of venous blood by venipuncture |
1,069 |
1,025 |
$626.38 |
| D0274 |
Bitewings - four radiographic images |
119 |
118 |
$579.25 |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
225 |
$424.95 |
| 0064A |
|
12 |
12 |
$360.00 |
| 90461 |
|
37 |
36 |
$193.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
81 |
$163.00 |
| D1206 |
Topical application of fluoride varnish |
906 |
875 |
$74.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
31 |
26 |
$57.85 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,160 |
1,048 |
$0.00 |
| 85018 |
|
91 |
89 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
12 |
12 |
$0.00 |
| 36416 |
|
169 |
162 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| D1353 |
|
62 |
28 |
$0.00 |
| D0190 |
|
463 |
425 |
$0.00 |
| 81003 |
|
37 |
28 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |