| 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 |
34,878 |
30,221 |
$2.58M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,264 |
4,242 |
$428K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,169 |
2,148 |
$421K |
| 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 |
3,753 |
3,728 |
$300K |
| D0140 |
Limited oral evaluation - problem focused |
2,627 |
2,564 |
$267K |
| 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 |
3,705 |
2,565 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,752 |
1,314 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
3,034 |
3,022 |
$208K |
| D1110 |
Prophylaxis - adult |
2,711 |
2,699 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,278 |
881 |
$131K |
| 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 |
1,959 |
1,909 |
$120K |
| D4355 |
|
758 |
752 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
3,565 |
3,548 |
$89K |
| D1120 |
Prophylaxis - child |
1,646 |
1,640 |
$66K |
| D1206 |
Topical application of fluoride varnish |
1,798 |
1,787 |
$43K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20,029 |
17,885 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
226 |
197 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,548 |
1,538 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
181 |
132 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,431 |
2,398 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
163 |
100 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,678 |
3,443 |
$17K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,736 |
1,735 |
$12K |
| D5110 |
|
12 |
12 |
$10K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,579 |
1,108 |
$9K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,709 |
1,652 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,317 |
4,257 |
$8K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,298 |
1,267 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,786 |
7,623 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,235 |
1,226 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,367 |
1,366 |
$7K |
| D0190 |
|
1,280 |
1,267 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
897 |
896 |
$4K |
| 90746 |
|
403 |
399 |
$4K |
| D0330 |
Panoramic radiographic image |
128 |
128 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,345 |
2,270 |
$4K |
| D2331 |
|
29 |
24 |
$3K |
| 90632 |
|
403 |
393 |
$3K |
| 99385 |
|
607 |
599 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,215 |
2,191 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
613 |
608 |
$2K |
| 0012A |
|
68 |
68 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
42 |
42 |
$2K |
| H0031 |
Mental health assessment, by non-physician |
66 |
64 |
$2K |
| 90651 |
|
14 |
14 |
$2K |
| D4341 |
|
21 |
12 |
$2K |
| 99383 |
|
85 |
85 |
$1K |
| 90707 |
|
115 |
114 |
$1K |
| 96127 |
|
5,915 |
5,824 |
$1K |
| 99386 |
|
49 |
48 |
$1K |
| 90686 |
|
595 |
593 |
$972.04 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,081 |
2,067 |
$913.44 |
| 90715 |
|
357 |
346 |
$913.36 |
| 99384 |
|
69 |
68 |
$894.33 |
| 98960 |
|
142 |
138 |
$882.36 |
| 92558 |
|
493 |
493 |
$868.79 |
| 99000 |
|
84 |
76 |
$820.36 |
| 99406 |
|
363 |
344 |
$769.71 |
| 81025 |
|
1,784 |
1,701 |
$757.65 |
| 90714 |
|
96 |
94 |
$644.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
86 |
$533.01 |
| 90832 |
Psychotherapy, 30 minutes with patient |
706 |
591 |
$531.33 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$502.20 |
| 90685 |
|
73 |
70 |
$458.01 |
| 0011A |
|
64 |
64 |
$373.02 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
47 |
47 |
$366.88 |
| 82962 |
|
3,195 |
2,889 |
$354.71 |
| 90656 |
|
18 |
18 |
$347.77 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
410 |
396 |
$249.09 |
| 80305 |
|
461 |
373 |
$229.17 |
| 90791 |
Psychiatric diagnostic evaluation |
52 |
52 |
$204.84 |
| 81002 |
|
1,651 |
1,624 |
$118.92 |
| 92551 |
|
292 |
292 |
$82.27 |
| 82950 |
|
139 |
125 |
$74.12 |
| 99188 |
|
107 |
107 |
$56.44 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
104 |
103 |
$35.00 |
| 87807 |
|
46 |
44 |
$21.70 |
| 87430 |
|
56 |
55 |
$11.83 |
| 92228 |
|
50 |
50 |
$8.09 |
| 3725F |
|
401 |
385 |
$0.00 |
| 82947 |
|
56 |
56 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
270 |
270 |
$0.00 |
| H0050 |
Alcohol and/or drug services, brief intervention, per 15 minutes |
502 |
501 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
231 |
152 |
$0.00 |
| 99173 |
|
338 |
338 |
$0.00 |
| 99382 |
|
26 |
26 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
18 |
18 |
$0.00 |
| 3078F |
|
29 |
28 |
$0.00 |
| 90670 |
|
43 |
43 |
$0.00 |
| 90461 |
|
56 |
56 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
34 |
34 |
$0.00 |
| 3077F |
|
20 |
17 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
2,804 |
2,792 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
129 |
129 |
$0.00 |
| 3044F |
|
411 |
408 |
$0.00 |
| 3074F |
|
27 |
26 |
$0.00 |
| H0049 |
Alcohol and/or drug screening |
22 |
22 |
$0.00 |
| 1000F |
|
29 |
25 |
$0.00 |
| 3008F |
|
166 |
166 |
$0.00 |
| 87428 |
|
28 |
28 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| 3075F |
|
18 |
16 |
$0.00 |
| 3080F |
|
15 |
14 |
$0.00 |
| 3079F |
|
21 |
19 |
$0.00 |