| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
972 |
952 |
$144.90 |
| D2331 |
|
218 |
160 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
431 |
406 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
3,666 |
3,510 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,479 |
993 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33,856 |
27,716 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
776 |
747 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,891 |
1,850 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,750 |
3,639 |
$0.00 |
| 36416 |
|
1,952 |
1,903 |
$0.00 |
| D1351 |
Sealant - per tooth |
646 |
247 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
795 |
771 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,672 |
1,931 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
10,404 |
6,802 |
$0.00 |
| 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 |
10,595 |
7,890 |
$0.00 |
| 87430 |
|
150 |
148 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
324 |
271 |
$0.00 |
| 94760 |
|
1,975 |
1,689 |
$0.00 |
| 99441 |
|
130 |
123 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
530 |
483 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
862 |
855 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,099 |
4,012 |
$0.00 |
| 90686 |
|
288 |
284 |
$0.00 |
| 87428 |
|
351 |
337 |
$0.00 |
| 90732 |
|
13 |
13 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
9,142 |
8,468 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
2,613 |
1,252 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,409 |
10,069 |
$0.00 |
| D2330 |
|
264 |
181 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
27 |
27 |
$0.00 |
| 84703 |
|
15 |
15 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
91 |
64 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
111 |
110 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
200 |
180 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
764 |
445 |
$0.00 |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
44 |
42 |
$0.00 |
| 87807 |
|
27 |
27 |
$0.00 |
| 90688 |
|
178 |
174 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
14 |
12 |
$0.00 |
| 93000 |
|
13 |
12 |
$0.00 |
| D2335 |
|
12 |
12 |
$0.00 |
| 99443 |
|
16 |
13 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
18 |
18 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
1,062 |
948 |
$0.00 |
| D0270 |
|
1,193 |
1,170 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,059 |
1,039 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,425 |
3,341 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,196 |
1,170 |
$0.00 |
| D4910 |
|
293 |
288 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,379 |
1,213 |
$0.00 |
| 81003 |
|
1,526 |
1,458 |
$0.00 |
| D1110 |
Prophylaxis - adult |
4,954 |
4,798 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,844 |
1,661 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,835 |
3,705 |
$0.00 |
| 80305 |
|
2,638 |
2,121 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
514 |
489 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
640 |
617 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,660 |
3,549 |
$0.00 |
| 83037 |
|
159 |
147 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,997 |
2,317 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,178 |
1,517 |
$0.00 |
| 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 |
2,603 |
1,552 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
287 |
262 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
597 |
290 |
$0.00 |
| 80061 |
Lipid panel |
608 |
604 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
377 |
355 |
$0.00 |
| D0330 |
Panoramic radiographic image |
733 |
725 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
35 |
26 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
794 |
777 |
$0.00 |
| 81002 |
|
654 |
609 |
$0.00 |
| D4341 |
|
84 |
48 |
$0.00 |
| 86703 |
|
70 |
70 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
241 |
230 |
$0.00 |
| 81025 |
|
397 |
349 |
$0.00 |
| 99442 |
|
44 |
41 |
$0.00 |
| 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 |
48 |
48 |
$0.00 |
| 90715 |
|
101 |
95 |
$0.00 |
| 98968 |
|
25 |
22 |
$0.00 |
| D2332 |
|
42 |
30 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
36 |
35 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
51 |
49 |
$0.00 |