| 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 |
279,245 |
224,499 |
$20.23M |
| 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 |
47,112 |
25,887 |
$3.48M |
| 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 |
34,472 |
34,250 |
$2.40M |
| D0140 |
Limited oral evaluation - problem focused |
26,047 |
24,687 |
$2.31M |
| D7140 |
Extraction, erupted tooth or exposed root |
17,660 |
9,701 |
$1.72M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,149 |
9,572 |
$1.63M |
| 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 |
16,538 |
16,287 |
$1.33M |
| D1110 |
Prophylaxis - adult |
14,931 |
14,810 |
$1.30M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,633 |
8,265 |
$1.21M |
| 59426 |
|
1,170 |
1,168 |
$1.09M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,957 |
12,864 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
17,343 |
17,244 |
$958K |
| D1351 |
Sealant - per tooth |
33,565 |
7,881 |
$860K |
| D1120 |
Prophylaxis - child |
18,034 |
17,989 |
$720K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,371 |
3,881 |
$687K |
| D0210 |
Intraoral - complete series of radiographic images |
12,127 |
11,925 |
$641K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
150,440 |
133,721 |
$531K |
| D1206 |
Topical application of fluoride varnish |
20,861 |
20,817 |
$527K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,305 |
2,643 |
$488K |
| G0469 |
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health 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 mental health visit |
5,462 |
5,372 |
$416K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
81,556 |
75,593 |
$412K |
| D2331 |
|
2,733 |
2,141 |
$313K |
| D0999 |
Unspecified diagnostic procedure, by report |
2,326 |
1,935 |
$302K |
| D2335 |
|
1,956 |
1,642 |
$294K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
322 |
315 |
$258K |
| D2332 |
|
2,016 |
1,657 |
$254K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
5,028 |
4,977 |
$252K |
| D0220 |
Intraoral - periapical first radiographic image |
17,060 |
16,524 |
$221K |
| D2330 |
|
2,297 |
1,728 |
$217K |
| D0274 |
Bitewings - four radiographic images |
7,622 |
7,577 |
$200K |
| D5110 |
|
251 |
249 |
$190K |
| D2394 |
|
992 |
934 |
$170K |
| D0191 |
|
9,593 |
9,580 |
$168K |
| D4355 |
|
1,088 |
1,081 |
$146K |
| D0330 |
Panoramic radiographic image |
3,183 |
3,155 |
$121K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
15,770 |
8,749 |
$103K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
11,820 |
11,790 |
$101K |
| D4910 |
|
958 |
957 |
$98K |
| D0272 |
Bitewings - two radiographic images |
4,767 |
4,748 |
$97K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
11,390 |
11,203 |
$80K |
| D0270 |
|
7,760 |
7,566 |
$78K |
| 99402 |
|
1,047 |
876 |
$77K |
| 90651 |
|
4,044 |
4,026 |
$75K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
7,927 |
7,894 |
$53K |
| 90834 |
Psychotherapy, 45 minutes with patient |
11,446 |
7,812 |
$47K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
41,814 |
41,404 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,501 |
1,494 |
$43K |
| D5120 |
|
79 |
79 |
$43K |
| D1354 |
|
2,891 |
1,930 |
$43K |
| D2940 |
|
472 |
446 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,275 |
4,437 |
$41K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
21,117 |
20,961 |
$40K |
| 99001 |
|
3,936 |
3,876 |
$37K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
5,176 |
5,116 |
$32K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
3,881 |
3,809 |
$31K |
| 90832 |
Psychotherapy, 30 minutes with patient |
14,286 |
9,141 |
$30K |
| 59430 |
|
1,159 |
1,153 |
$27K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
11,135 |
3,579 |
$27K |
| 0001A |
|
786 |
781 |
$25K |
| 99381 |
|
3,088 |
3,082 |
$24K |
| 90739 |
|
1,743 |
1,737 |
$24K |
| 90480 |
|
917 |
915 |
$24K |
| 86328 |
|
2,961 |
2,919 |
$23K |
| 90632 |
|
4,086 |
4,069 |
$23K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,877 |
4,855 |
$22K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
1,309 |
1,292 |
$22K |
| G0512 |
Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month |
274 |
274 |
$22K |
| 0002A |
|
579 |
579 |
$21K |
| 99495 |
|
2,513 |
2,465 |
$21K |
| H0031 |
Mental health assessment, by non-physician |
1,946 |
1,939 |
$20K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,818 |
3,784 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
3,116 |
3,063 |
$19K |
| 96160 |
|
5,494 |
5,461 |
$19K |
| 0012A |
|
523 |
522 |
$18K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,914 |
1,906 |
$18K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
5,018 |
4,753 |
$17K |
| 90791 |
Psychiatric diagnostic evaluation |
2,651 |
2,639 |
$17K |
| 92002 |
|
2,714 |
2,602 |
$16K |
| 0011A |
|
557 |
553 |
$16K |
| H2011 |
Crisis intervention service, per 15 minutes |
1,646 |
1,582 |
$15K |
| 91320 |
|
598 |
596 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,730 |
6,377 |
$15K |
| 99215 |
Prolong outpt/office vis |
2,005 |
1,961 |
$14K |
| 90715 |
|
5,535 |
5,484 |
$14K |
| 90686 |
|
16,682 |
16,597 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
20 |
17 |
$12K |
| 90837 |
Psychotherapy, 53 minutes with patient |
3,060 |
2,183 |
$11K |
| 0124A |
|
456 |
452 |
$11K |
| 92015 |
Determination of refractive state |
8,837 |
8,663 |
$9K |
| 59425 |
|
14 |
14 |
$9K |
| 0053A |
|
345 |
345 |
$9K |
| H2000 |
Comprehensive multidisciplinary evaluation |
106 |
97 |
$9K |
| 59025 |
Fetal non-stress test |
3,687 |
1,366 |
$8K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
6,235 |
2,370 |
$8K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
2,264 |
2,242 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
6,164 |
6,042 |
$7K |
| V2020 |
Frames, purchases |
453 |
430 |
$7K |
| 0071A |
|
198 |
198 |
$7K |
| 0051A |
|
210 |
208 |
$6K |
| 0031A |
|
172 |
171 |
$6K |
| 99383 |
|
511 |
510 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
7,118 |
7,078 |
$5K |
| 0072A |
|
135 |
135 |
$5K |
| 97161 |
|
1,185 |
1,161 |
$5K |
| 0013A |
|
126 |
126 |
$4K |
| 81025 |
|
5,799 |
5,649 |
$4K |
| 90656 |
|
978 |
974 |
$4K |
| 0052A |
|
128 |
128 |
$4K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
867 |
853 |
$4K |
| 90474 |
|
5,839 |
5,825 |
$4K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
1,796 |
678 |
$4K |
| 0003A |
|
122 |
122 |
$4K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
2,271 |
2,126 |
$4K |
| 90746 |
|
682 |
675 |
$3K |
| 99382 |
|
346 |
346 |
$3K |
| 99385 |
|
426 |
421 |
$3K |
| D2950 |
|
19 |
17 |
$3K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
128 |
128 |
$3K |
| 92250 |
|
1,627 |
1,625 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,394 |
3,387 |
$3K |
| 90732 |
|
345 |
342 |
$3K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
161 |
161 |
$3K |
| 0054A |
|
111 |
111 |
$3K |
| Q3014 |
Telehealth originating site facility fee |
651 |
618 |
$3K |
| 96130 |
|
236 |
235 |
$3K |
| 90620 |
|
606 |
604 |
$2K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,202 |
825 |
$2K |
| 0081A |
|
69 |
69 |
$2K |
| 81002 |
|
7,364 |
7,143 |
$2K |
| 97162 |
|
337 |
337 |
$2K |
| 83655 |
|
1,344 |
1,343 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
325 |
321 |
$2K |
| 96127 |
|
4,465 |
4,290 |
$1K |
| 90619 |
|
1,307 |
1,305 |
$1K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
82 |
78 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
773 |
771 |
$1K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
1,123 |
996 |
$1K |
| 1159F |
|
63,760 |
56,088 |
$1K |
| 93000 |
|
1,369 |
1,350 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
50 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
565 |
511 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,355 |
1,345 |
$888.25 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
215 |
155 |
$852.00 |
| 11982 |
|
95 |
95 |
$811.15 |
| 99406 |
|
838 |
823 |
$697.68 |
| D3120 |
|
660 |
609 |
$665.60 |
| 90688 |
|
867 |
854 |
$624.40 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
574 |
499 |
$591.24 |
| 17110 |
|
208 |
172 |
$564.01 |
| 96101 |
|
121 |
116 |
$553.92 |
| 0154A |
|
18 |
17 |
$522.35 |
| 99205 |
Prolong outpt/office vis |
77 |
77 |
$462.96 |
| 82962 |
|
1,496 |
1,407 |
$418.67 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
624 |
593 |
$411.29 |
| 11721 |
|
170 |
170 |
$399.56 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
26 |
25 |
$384.69 |
| 90734 |
|
2,110 |
2,089 |
$373.85 |
| 92341 |
|
270 |
245 |
$371.68 |
| 76801 |
|
24 |
24 |
$348.65 |
| 85018 |
|
1,338 |
1,337 |
$337.12 |
| 90707 |
|
2,306 |
2,300 |
$325.00 |
| 0121A |
|
45 |
45 |
$320.63 |
| 99384 |
|
102 |
102 |
$298.11 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
17 |
16 |
$297.58 |
| 0151A |
|
16 |
16 |
$281.06 |
| 91322 |
|
13 |
13 |
$260.00 |
| 58300 |
|
43 |
42 |
$237.33 |
| 98926 |
|
107 |
91 |
$229.78 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
141 |
141 |
$212.16 |
| 96381 |
|
63 |
63 |
$207.27 |
| 0171A |
|
13 |
13 |
$161.96 |
| 11981 |
|
93 |
92 |
$160.46 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
25 |
24 |
$153.48 |
| 99386 |
|
12 |
12 |
$117.10 |
| 0073A |
|
13 |
13 |
$112.59 |
| 90716 |
|
2,288 |
2,283 |
$112.00 |
| 92228 |
|
105 |
105 |
$110.92 |
| 80305 |
|
151 |
140 |
$104.30 |
| 11055 |
|
26 |
25 |
$91.16 |
| 90714 |
|
63 |
61 |
$90.00 |
| 1160F |
|
176,276 |
154,847 |
$78.07 |
| 3078F |
|
81,974 |
75,654 |
$78.02 |
| 1032F |
|
65,416 |
57,874 |
$78.02 |
| 1035F |
|
3,461 |
3,047 |
$78.01 |
| 87400 |
|
22 |
22 |
$70.20 |
| 76830 |
Ultrasound, transvaginal |
28 |
28 |
$68.94 |
| 82044 |
|
122 |
121 |
$67.08 |
| 82570 |
|
140 |
139 |
$65.31 |
| 99201 |
|
13 |
13 |
$25.55 |
| 99606 |
|
17 |
17 |
$25.00 |
| 94760 |
|
5,673 |
5,349 |
$24.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,980 |
2,661 |
$13.60 |
| 4010F |
|
26,238 |
21,984 |
$0.02 |
| 3008F |
|
87,584 |
82,931 |
$0.01 |
| 3074F |
|
100,109 |
91,452 |
$0.01 |
| 1036F |
|
48,723 |
43,529 |
$0.01 |
| 3052F |
|
508 |
508 |
$0.01 |
| 4000F |
|
40,475 |
35,709 |
$0.00 |
| 3075F |
|
16,932 |
16,359 |
$0.00 |
| 90696 |
|
2,033 |
2,030 |
$0.00 |
| 3044F |
|
2,375 |
2,368 |
$0.00 |
| 90647 |
|
4,876 |
4,863 |
$0.00 |
| 90680 |
|
5,908 |
5,899 |
$0.00 |
| 1031F |
|
10,083 |
9,314 |
$0.00 |
| 3079F |
|
36,422 |
34,413 |
$0.00 |
| 1157F |
|
5,972 |
5,494 |
$0.00 |
| 90677 |
|
1,250 |
1,250 |
$0.00 |
| 0500F |
|
1,262 |
1,254 |
$0.00 |
| 90697 |
|
3,279 |
3,276 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
498 |
498 |
$0.00 |
| 4037F |
|
5,214 |
5,200 |
$0.00 |
| 3080F |
|
12,358 |
11,568 |
$0.00 |
| 91307 |
|
475 |
462 |
$0.00 |
| 90381 |
|
38 |
38 |
$0.00 |
| 0503F |
|
1,187 |
1,133 |
$0.00 |
| 1034F |
|
42,178 |
36,647 |
$0.00 |
| 3072F |
|
214 |
214 |
$0.00 |
| 90723 |
|
4,122 |
4,113 |
$0.00 |
| 2023F |
|
180 |
180 |
$0.00 |
| 91305 |
|
826 |
823 |
$0.00 |
| 91303 |
|
153 |
152 |
$0.00 |
| 91301 |
|
1,106 |
1,089 |
$0.00 |
| 91317 |
|
20 |
19 |
$0.00 |
| 97014 |
|
24 |
14 |
$0.00 |
| 2000F |
|
9,416 |
7,814 |
$0.00 |
| 91318 |
|
56 |
56 |
$0.00 |
| 1111F |
|
44 |
44 |
$0.00 |
| D9995 |
|
266 |
260 |
$0.00 |
| 91315 |
|
35 |
34 |
$0.00 |
| 91319 |
|
13 |
13 |
$0.00 |
| 97802 |
|
14 |
12 |
$0.00 |
| 57454 |
|
14 |
14 |
$0.00 |
| 90633 |
|
5,519 |
5,499 |
$0.00 |
| 3077F |
|
13,714 |
12,783 |
$0.00 |
| 90700 |
|
2,308 |
2,301 |
$0.00 |
| 90710 |
|
2,499 |
2,498 |
$0.00 |
| 90670 |
|
7,934 |
7,918 |
$0.00 |
| 0502F |
|
12,671 |
2,378 |
$0.00 |
| 1033F |
|
588 |
519 |
$0.00 |
| 99051 |
|
625 |
619 |
$0.00 |
| 4040F |
|
1,945 |
1,942 |
$0.00 |
| G9919 |
Screening performed and positive and provision of recommendations |
654 |
653 |
$0.00 |
| 3051F |
|
921 |
920 |
$0.00 |
| 4004F |
|
36,146 |
32,190 |
$0.00 |
| 3046F |
|
1,392 |
1,386 |
$0.00 |
| 91312 |
|
472 |
470 |
$0.00 |
| 90687 |
|
99 |
98 |
$0.00 |
| 2028F |
|
1,531 |
1,523 |
$0.00 |
| 91308 |
|
98 |
96 |
$0.00 |
| 3045F |
|
43 |
43 |
$0.00 |
| 90713 |
|
84 |
84 |
$0.00 |
| G9920 |
Screening performed and negative |
882 |
880 |
$0.00 |
| 91321 |
|
141 |
141 |
$0.00 |
| 4001F |
|
137 |
137 |
$0.00 |
| 91300 |
|
1,399 |
1,289 |
$0.00 |
| 80061 |
Lipid panel |
44 |
44 |
$0.00 |
| 90380 |
|
19 |
19 |
$0.00 |
| 82947 |
|
30 |
30 |
$0.00 |
| 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 |
24 |
24 |
$0.00 |