| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,354 |
6,004 |
$308K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,105 |
7,489 |
$298K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,774 |
2,783 |
$121K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,881 |
2,198 |
$103K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,570 |
1,237 |
$96K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,847 |
833 |
$74K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,014 |
807 |
$73K |
| 96160 |
|
6,761 |
3,436 |
$71K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,093 |
809 |
$62K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
462 |
326 |
$23K |
| 96127 |
|
3,939 |
2,200 |
$23K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
356 |
106 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
54 |
$11K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
187 |
177 |
$9K |
| D1110 |
Prophylaxis - adult |
210 |
207 |
$9K |
| 90837 |
Psychotherapy, 53 minutes with patient |
117 |
68 |
$9K |
| D1206 |
Topical application of fluoride varnish |
313 |
307 |
$7K |
| 99215 |
Prolong outpt/office vis |
63 |
59 |
$6K |
| 3008F |
|
4,608 |
3,691 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
167 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
78 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
158 |
157 |
$4K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
50 |
26 |
$4K |
| 92551 |
|
453 |
319 |
$3K |
| 81003 |
|
2,128 |
1,336 |
$3K |
| 99173 |
|
357 |
266 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
53 |
44 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
19 |
12 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
122 |
61 |
$1K |
| 81002 |
|
457 |
225 |
$1K |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
13 |
12 |
$846.92 |
| 90461 |
|
2,030 |
1,206 |
$737.66 |
| 96161 |
|
139 |
90 |
$620.41 |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
43 |
$538.27 |
| 90651 |
|
450 |
347 |
$516.00 |
| 99406 |
|
122 |
65 |
$497.87 |
| 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 |
28 |
27 |
$449.87 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$420.75 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
66 |
32 |
$315.26 |
| 36416 |
|
339 |
209 |
$243.78 |
| 36415 |
Collection of venous blood by venipuncture |
76 |
53 |
$199.54 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
12 |
$197.00 |
| 90734 |
|
188 |
154 |
$165.61 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
12 |
$140.35 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
19 |
12 |
$138.54 |
| 90686 |
|
602 |
424 |
$72.94 |
| 90756 |
|
18 |
12 |
$70.71 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
17 |
14 |
$50.91 |
| 90688 |
|
442 |
369 |
$0.00 |
| 90680 |
|
22 |
14 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
214 |
120 |
$0.00 |
| 0502F |
|
1,878 |
1,161 |
$0.00 |
| 90670 |
|
214 |
157 |
$0.00 |
| 99072 |
|
98 |
90 |
$0.00 |
| 90633 |
|
84 |
48 |
$0.00 |
| 90685 |
|
41 |
30 |
$0.00 |
| 90715 |
|
42 |
24 |
$0.00 |
| 90687 |
|
19 |
12 |
$0.00 |