| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,565 |
10,614 |
$1.05M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,480 |
6,342 |
$778K |
| D0140 |
Limited oral evaluation - problem focused |
7,102 |
3,230 |
$245K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,237 |
1,258 |
$228K |
| D1110 |
Prophylaxis - adult |
3,713 |
2,419 |
$223K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,412 |
982 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
3,583 |
2,519 |
$160K |
| D1120 |
Prophylaxis - child |
2,519 |
1,785 |
$121K |
| 99215 |
Prolong outpt/office vis |
895 |
534 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,299 |
695 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,762 |
1,689 |
$47K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
3,185 |
2,240 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
683 |
383 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,238 |
1,077 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,071 |
582 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
299 |
$36K |
| 90837 |
Psychotherapy, 53 minutes with patient |
391 |
168 |
$31K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
945 |
843 |
$27K |
| 36415 |
Collection of venous blood by venipuncture |
2,529 |
1,599 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
176 |
83 |
$11K |
| D1351 |
Sealant - per tooth |
359 |
80 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
696 |
685 |
$10K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
89 |
58 |
$9K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
155 |
77 |
$9K |
| 96127 |
|
593 |
131 |
$8K |
| 99173 |
|
829 |
342 |
$7K |
| 99406 |
|
383 |
154 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
100 |
55 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
427 |
419 |
$7K |
| 90686 |
|
365 |
276 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
74 |
$5K |
| D0272 |
Bitewings - two radiographic images |
252 |
210 |
$5K |
| 0012A |
|
123 |
123 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
301 |
281 |
$4K |
| 0011A |
|
124 |
124 |
$4K |
| 99385 |
|
51 |
24 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
241 |
122 |
$4K |
| 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 |
240 |
92 |
$4K |
| 99051 |
|
438 |
436 |
$4K |
| 0064A |
|
81 |
81 |
$3K |
| 92551 |
|
338 |
321 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
180 |
$3K |
| 99442 |
|
67 |
40 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
35 |
25 |
$3K |
| 86701 |
|
178 |
76 |
$2K |
| D0603 |
|
499 |
461 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
77 |
68 |
$2K |
| 0072A |
|
36 |
36 |
$2K |
| 99441 |
|
31 |
19 |
$1K |
| D0330 |
Panoramic radiographic image |
22 |
12 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
43 |
13 |
$942.42 |
| 0031A |
|
23 |
23 |
$920.00 |
| 97803 |
|
15 |
14 |
$686.82 |
| 0071A |
|
16 |
16 |
$640.00 |
| 90688 |
|
27 |
27 |
$480.22 |
| D0270 |
|
15 |
15 |
$205.80 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
70 |
70 |
$172.41 |
| D0602 |
|
118 |
117 |
$140.40 |
| 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 |
26 |
26 |
$86.23 |
| D0601 |
|
128 |
127 |
$0.00 |
| 99000 |
|
44 |
43 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$0.00 |
| D1999 |
|
55 |
48 |
$0.00 |