| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
8,334 |
7,044 |
$1.55M |
| T1015 |
Clinic visit/encounter, all-inclusive |
6,804 |
5,024 |
$1.17M |
| D0999 |
Unspecified diagnostic procedure, by report |
5,508 |
4,835 |
$986K |
| 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 |
292 |
229 |
$11K |
| D1206 |
Topical application of fluoride varnish |
4,203 |
4,105 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,049 |
3,881 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
2,834 |
2,779 |
$2K |
| D1120 |
Prophylaxis - child |
2,660 |
2,590 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,019 |
1,975 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
1,022 |
682 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
507 |
408 |
$1K |
| D1110 |
Prophylaxis - adult |
1,126 |
1,107 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
610 |
$1K |
| D0603 |
|
1,047 |
1,022 |
$670.00 |
| D0274 |
Bitewings - four radiographic images |
1,219 |
1,201 |
$544.49 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
41 |
38 |
$386.61 |
| D0330 |
Panoramic radiographic image |
1,504 |
1,482 |
$274.61 |
| D0220 |
Intraoral - periapical first radiographic image |
2,212 |
2,147 |
$224.32 |
| D0140 |
Limited oral evaluation - problem focused |
1,032 |
997 |
$182.85 |
| D0272 |
Bitewings - two radiographic images |
410 |
401 |
$136.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,153 |
322 |
$60.76 |
| D0602 |
|
61 |
59 |
$50.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
54 |
53 |
$6.30 |
| D0270 |
|
269 |
265 |
$0.92 |
| D0460 |
|
274 |
267 |
$0.62 |
| 3079F |
|
109 |
99 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
383 |
326 |
$0.00 |
| D1330 |
|
226 |
226 |
$0.00 |
| D0601 |
|
43 |
41 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,174 |
1,057 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
201 |
174 |
$0.00 |
| D9995 |
|
18 |
15 |
$0.00 |
| 3074F |
|
180 |
130 |
$0.00 |
| 90688 |
|
90 |
69 |
$0.00 |
| 3080F |
|
85 |
71 |
$0.00 |
| 36416 |
|
28 |
26 |
$0.00 |
| 94760 |
|
141 |
133 |
$0.00 |
| D1351 |
Sealant - per tooth |
216 |
76 |
$0.00 |
| 3075F |
|
17 |
16 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
128 |
126 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
112 |
85 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
13 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
117 |
101 |
$0.00 |
| 3077F |
|
79 |
65 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
50 |
48 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
200 |
103 |
$0.00 |
| 90756 |
|
46 |
46 |
$0.00 |
| 3078F |
|
85 |
70 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
19 |
14 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
41 |
35 |
$0.00 |