| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,553 |
16,376 |
$2.47M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,626 |
2,260 |
$372K |
| 99442 |
|
2,520 |
2,342 |
$329K |
| D1110 |
Prophylaxis - adult |
6,867 |
2,884 |
$255K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,462 |
1,654 |
$226K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,409 |
1,025 |
$136K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,292 |
905 |
$121K |
| 99443 |
|
897 |
838 |
$119K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
598 |
500 |
$98K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,040 |
642 |
$87K |
| 99441 |
|
627 |
531 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,784 |
2,454 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
903 |
473 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,464 |
683 |
$54K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
535 |
309 |
$43K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
358 |
256 |
$33K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
287 |
180 |
$25K |
| 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 |
1,172 |
428 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,172 |
1,155 |
$18K |
| D0330 |
Panoramic radiographic image |
611 |
557 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
58 |
57 |
$8K |
| D1120 |
Prophylaxis - child |
172 |
117 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
174 |
$5K |
| 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 |
27 |
27 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
566 |
559 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
156 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
22 |
15 |
$3K |
| 92002 |
|
14 |
13 |
$2K |
| 99385 |
|
21 |
12 |
$1K |
| D2140 |
|
48 |
40 |
$1K |
| 99497 |
|
12 |
12 |
$909.00 |
| D0270 |
|
53 |
53 |
$458.44 |
| D1330 |
|
781 |
780 |
$0.00 |
| D0603 |
|
103 |
103 |
$0.00 |
| D0602 |
|
44 |
44 |
$0.00 |