| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
66,748 |
50,894 |
$4.48M |
| 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 |
2,257 |
1,993 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,124 |
2,868 |
$529.96 |
| 90791 |
Psychiatric diagnostic evaluation |
1,161 |
960 |
$526.55 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
250 |
223 |
$175.49 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,723 |
12,612 |
$73.00 |
| 99442 |
|
7,075 |
5,858 |
$67.74 |
| D0190 |
|
4,900 |
4,623 |
$52.52 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,012 |
2,548 |
$20.60 |
| 97802 |
|
1,835 |
1,700 |
$7.34 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,988 |
1,830 |
$4.02 |
| 99383 |
|
14 |
14 |
$0.82 |
| 90670 |
|
2,110 |
1,970 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
11,597 |
10,371 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,348 |
5,765 |
$0.00 |
| 90633 |
|
695 |
642 |
$0.00 |
| D1120 |
Prophylaxis - child |
16,000 |
14,382 |
$0.00 |
| 90648 |
|
721 |
705 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,688 |
1,681 |
$0.00 |
| 90461 |
|
3,290 |
3,071 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,339 |
2,095 |
$0.00 |
| 90710 |
|
273 |
261 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
3,175 |
2,845 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
490 |
458 |
$0.00 |
| 99173 |
|
1,507 |
1,413 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
478 |
434 |
$0.00 |
| D0191 |
|
190 |
190 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,301 |
1,172 |
$0.00 |
| 97803 |
|
1,905 |
1,763 |
$0.00 |
| D0270 |
|
1,054 |
971 |
$0.00 |
| 96152 |
|
172 |
117 |
$0.00 |
| D0330 |
Panoramic radiographic image |
3,065 |
2,864 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
4,728 |
4,255 |
$0.00 |
| D2940 |
|
13 |
12 |
$0.00 |
| 91300 |
|
168 |
158 |
$0.00 |
| D1354 |
|
1,134 |
398 |
$0.00 |
| 81003 |
|
1,224 |
839 |
$0.00 |
| 90734 |
|
12 |
12 |
$0.00 |
| 0002A |
|
58 |
58 |
$0.00 |
| 92552 |
|
695 |
653 |
$0.00 |
| 99177 |
|
325 |
291 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
150 |
130 |
$0.00 |
| 90685 |
|
210 |
207 |
$0.00 |
| 86328 |
|
108 |
104 |
$0.00 |
| 0071A |
|
27 |
27 |
$0.00 |
| D4341 |
|
31 |
14 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
148 |
68 |
$0.00 |
| D4910 |
|
14 |
14 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
35 |
28 |
$0.00 |
| 81025 |
|
12 |
12 |
$0.00 |
| 0124A |
|
12 |
12 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
611 |
568 |
$0.00 |
| 96156 |
|
1,327 |
1,230 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,638 |
2,349 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
313 |
246 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
12,804 |
11,450 |
$0.00 |
| D0602 |
|
778 |
632 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
19,820 |
17,889 |
$0.00 |
| 0001A |
|
94 |
93 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,802 |
2,951 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,527 |
8,425 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
3,965 |
3,416 |
$0.00 |
| D0240 |
|
5,542 |
2,955 |
$0.00 |
| 92558 |
|
684 |
636 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,303 |
2,037 |
$0.00 |
| 90686 |
|
1,331 |
1,140 |
$0.00 |
| 0011A |
|
75 |
75 |
$0.00 |
| 82962 |
|
632 |
560 |
$0.00 |
| 96154 |
|
203 |
156 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
846 |
486 |
$0.00 |
| 90688 |
|
246 |
240 |
$0.00 |
| D1330 |
|
13,647 |
11,280 |
$0.00 |
| 90697 |
|
393 |
345 |
$0.00 |
| 90723 |
|
632 |
619 |
$0.00 |
| 99422 |
|
201 |
183 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
143 |
113 |
$0.00 |
| D0601 |
|
934 |
778 |
$0.00 |
| D1351 |
Sealant - per tooth |
6,088 |
1,948 |
$0.00 |
| 90680 |
|
1,217 |
1,132 |
$0.00 |
| D0603 |
|
1,597 |
1,307 |
$0.00 |
| 91301 |
|
105 |
105 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
282 |
263 |
$0.00 |
| D0604 |
|
160 |
147 |
$0.00 |
| 0064A |
|
25 |
25 |
$0.00 |
| D1355 |
|
21 |
13 |
$0.00 |
| 90698 |
|
141 |
137 |
$0.00 |
| 0072A |
|
28 |
28 |
$0.00 |
| D4346 |
|
19 |
19 |
$0.00 |
| 91307 |
|
74 |
67 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
165 |
153 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| D7111 |
|
16 |
15 |
$0.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
13 |
13 |
$0.00 |
| 0012A |
|
43 |
43 |
$0.00 |
| 91306 |
|
24 |
24 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 99441 |
|
16 |
16 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |