| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,226 |
10,812 |
$403K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,345 |
1,117 |
$91K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,076 |
1,049 |
$78K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
636 |
597 |
$51K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
730 |
706 |
$49K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
431 |
375 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
299 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,553 |
3,424 |
$7K |
| D1120 |
Prophylaxis - child |
302 |
301 |
$7K |
| 90686 |
|
1,985 |
1,924 |
$2K |
| D1206 |
Topical application of fluoride varnish |
501 |
496 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,677 |
2,093 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,141 |
1,071 |
$1K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$1K |
| D0350 |
|
367 |
355 |
$952.46 |
| 90620 |
|
344 |
338 |
$813.94 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
269 |
260 |
$715.00 |
| D0120 |
Periodic oral evaluation - established patient |
38 |
37 |
$555.56 |
| 90651 |
|
364 |
355 |
$474.62 |
| D1330 |
|
543 |
532 |
$286.68 |
| 81003 |
|
1,243 |
1,163 |
$183.92 |
| 90461 |
|
691 |
667 |
$168.63 |
| 0011A |
|
14 |
12 |
$140.52 |
| 85018 |
|
594 |
557 |
$132.38 |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
114 |
$128.76 |
| 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 |
20 |
12 |
$120.00 |
| 90670 |
|
153 |
152 |
$101.47 |
| D0191 |
|
14 |
14 |
$83.60 |
| 3074F |
|
27 |
25 |
$75.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
180 |
76 |
$47.81 |
| 90633 |
|
57 |
55 |
$20.00 |
| 82962 |
|
39 |
27 |
$11.31 |
| 87430 |
|
14 |
14 |
$8.07 |
| 96161 |
|
17 |
15 |
$6.33 |
| 90734 |
|
103 |
102 |
$5.00 |
| 90715 |
|
53 |
52 |
$5.00 |
| D1310 |
|
227 |
221 |
$0.00 |
| 90647 |
|
42 |
42 |
$0.00 |
| 92551 |
|
84 |
84 |
$0.00 |
| 87428 |
|
26 |
26 |
$0.00 |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
164 |
157 |
$0.00 |
| 91301 |
|
32 |
30 |
$0.00 |
| 90723 |
|
13 |
13 |
$0.00 |
| 90680 |
|
36 |
36 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28 |
28 |
$0.00 |
| 1160F |
|
140 |
132 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
181 |
172 |
$0.00 |
| 90685 |
|
17 |
16 |
$0.00 |
| D9996 |
|
107 |
104 |
$0.00 |
| 1159F |
|
140 |
132 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 91300 |
|
12 |
12 |
$0.00 |
| 90621 |
|
14 |
13 |
$0.00 |
| 99173 |
|
15 |
15 |
$0.00 |