| 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 |
12,135 |
10,641 |
$877K |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
3,260 |
3,236 |
$259K |
| D0140 |
Limited oral evaluation - problem focused |
2,224 |
2,171 |
$200K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,559 |
929 |
$176K |
| 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 |
2,062 |
1,697 |
$156K |
| D1110 |
Prophylaxis - adult |
1,481 |
1,477 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
869 |
693 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
766 |
764 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
587 |
485 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,140 |
1,138 |
$47K |
| 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 |
230 |
226 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,455 |
2,388 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,176 |
6,420 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
581 |
576 |
$18K |
| D0274 |
Bitewings - four radiographic images |
789 |
788 |
$18K |
| D1120 |
Prophylaxis - child |
415 |
415 |
$17K |
| D1206 |
Topical application of fluoride varnish |
655 |
655 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,603 |
4,315 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,757 |
2,714 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
951 |
803 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,204 |
1,197 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
526 |
379 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
78 |
13 |
$2K |
| 90651 |
|
82 |
82 |
$2K |
| 0011A |
|
67 |
66 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
279 |
279 |
$1K |
| D0270 |
|
231 |
229 |
$1K |
| 0012A |
|
37 |
37 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
200 |
200 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
253 |
253 |
$1K |
| H0031 |
Mental health assessment, by non-physician |
161 |
155 |
$1K |
| 0031A |
|
22 |
22 |
$832.70 |
| 0064A |
|
23 |
23 |
$794.85 |
| 90686 |
|
1,013 |
995 |
$703.70 |
| 80305 |
|
968 |
760 |
$558.38 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$528.00 |
| 90632 |
|
60 |
60 |
$521.91 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
44 |
41 |
$449.45 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
144 |
134 |
$360.38 |
| 90746 |
|
28 |
28 |
$310.00 |
| 90620 |
|
24 |
24 |
$169.60 |
| 85018 |
|
627 |
619 |
$162.22 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
274 |
273 |
$157.62 |
| 90656 |
|
54 |
54 |
$156.45 |
| 90734 |
|
49 |
49 |
$120.00 |
| 94150 |
|
62 |
52 |
$76.52 |
| 82947 |
|
190 |
172 |
$59.30 |
| 81025 |
|
127 |
102 |
$50.59 |
| 90715 |
|
74 |
74 |
$30.95 |
| 81002 |
|
146 |
132 |
$24.49 |
| 93000 |
|
12 |
12 |
$10.27 |
| D1330 |
|
240 |
240 |
$0.00 |
| 94760 |
|
446 |
392 |
$0.00 |
| 36416 |
|
101 |
101 |
$0.00 |
| 91303 |
|
20 |
20 |
$0.00 |
| 91301 |
|
121 |
121 |
$0.00 |
| 90633 |
|
27 |
27 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$0.00 |
| 90670 |
|
51 |
51 |
$0.00 |
| 90685 |
|
25 |
25 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
23 |
12 |
$0.00 |
| 90648 |
|
24 |
24 |
$0.00 |