| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,215 |
7,968 |
$485K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,942 |
5,358 |
$242K |
| 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 |
4,823 |
4,103 |
$57K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
732 |
643 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
178 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
28 |
27 |
$1K |
| 87650 |
|
315 |
253 |
$1K |
| 81000 |
|
821 |
701 |
$660.44 |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
25 |
$479.05 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$101.08 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
13 |
$33.99 |
| G0008 |
Administration of influenza virus vaccine |
91 |
90 |
$20.83 |
| 90686 |
|
109 |
102 |
$15.49 |
| 3008F |
|
218 |
185 |
$0.00 |
| 1220F |
|
221 |
182 |
$0.00 |
| 84703 |
|
216 |
182 |
$0.00 |
| 1036F |
|
109 |
90 |
$0.00 |
| 3351F |
|
172 |
144 |
$0.00 |
| D1330 |
|
36 |
32 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$0.00 |
| 90674 |
|
41 |
39 |
$0.00 |
| 87400 |
|
112 |
89 |
$0.00 |
| 1159F |
|
213 |
181 |
$0.00 |
| 4551F |
|
213 |
183 |
$0.00 |
| 81025 |
|
15 |
14 |
$0.00 |
| 3078F |
|
12 |
12 |
$0.00 |
| 99173 |
|
18 |
16 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |