| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28,395 |
24,664 |
$606K |
| T1015 |
Clinic visit/encounter, all-inclusive |
4,025 |
3,904 |
$230K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,577 |
3,472 |
$195K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,672 |
2,590 |
$146K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,194 |
2,106 |
$130K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,648 |
1,582 |
$90K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,444 |
2,830 |
$69K |
| H1000 |
Prenatal care, at-risk assessment |
1,548 |
1,093 |
$59K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,044 |
1,929 |
$43K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
754 |
534 |
$41K |
| D9995 |
|
568 |
565 |
$26K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
13,626 |
13,063 |
$20K |
| 99442 |
|
779 |
665 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
179 |
$7K |
| 99441 |
|
1,088 |
876 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
554 |
531 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
131 |
128 |
$5K |
| D1110 |
Prophylaxis - adult |
163 |
163 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
82 |
81 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
82 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
74 |
$4K |
| D0274 |
Bitewings - four radiographic images |
274 |
272 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
41 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
706 |
694 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
90 |
89 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
2,785 |
2,646 |
$1K |
| 99443 |
|
45 |
43 |
$1K |
| 90686 |
|
5,508 |
5,435 |
$845.32 |
| D0330 |
Panoramic radiographic image |
95 |
94 |
$759.14 |
| 99215 |
Prolong outpt/office vis |
14 |
14 |
$651.36 |
| 96127 |
|
3,737 |
3,080 |
$648.14 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
535 |
348 |
$635.51 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
44 |
44 |
$595.92 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
51 |
46 |
$474.30 |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
157 |
$464.57 |
| 90474 |
|
502 |
490 |
$406.00 |
| 99422 |
|
93 |
79 |
$291.92 |
| 98940 |
|
18 |
13 |
$245.43 |
| D1351 |
Sealant - per tooth |
65 |
19 |
$221.34 |
| 90461 |
|
4,767 |
3,655 |
$201.20 |
| 86580 |
|
470 |
450 |
$184.73 |
| 98968 |
|
24 |
24 |
$131.35 |
| D1330 |
|
873 |
868 |
$120.10 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
171 |
167 |
$89.28 |
| D1206 |
Topical application of fluoride varnish |
140 |
140 |
$85.00 |
| 90633 |
|
576 |
569 |
$66.32 |
| 3074F |
|
4,189 |
3,664 |
$50.00 |
| 90685 |
|
223 |
220 |
$44.00 |
| 90651 |
|
359 |
348 |
$40.00 |
| 90648 |
|
828 |
814 |
$28.00 |
| 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 |
483 |
344 |
$23.42 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
12 |
$23.10 |
| 90670 |
|
1,460 |
1,429 |
$20.00 |
| 90620 |
|
55 |
54 |
$10.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
28 |
28 |
$10.00 |
| 90710 |
|
197 |
191 |
$10.00 |
| 90680 |
|
475 |
463 |
$8.00 |
| 81025 |
|
13 |
12 |
$5.26 |
| 90723 |
|
551 |
538 |
$0.00 |
| 1126F |
|
3,349 |
2,824 |
$0.00 |
| 1036F |
|
1,590 |
1,355 |
$0.00 |
| 3008F |
|
4,425 |
4,040 |
$0.00 |
| 1170F |
|
900 |
791 |
$0.00 |
| 92551 |
|
2,044 |
1,981 |
$0.00 |
| 90656 |
|
162 |
152 |
$0.00 |
| 99000 |
|
208 |
194 |
$0.00 |
| 3079F |
|
132 |
116 |
$0.00 |
| 1125F |
|
155 |
137 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
31 |
27 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 3044F |
|
32 |
32 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 3080F |
|
15 |
12 |
$0.00 |
| 3014F |
|
13 |
13 |
$0.00 |
| 1160F |
|
6,310 |
5,651 |
$0.00 |
| 3078F |
|
3,994 |
3,488 |
$0.00 |
| 3725F |
|
743 |
690 |
$0.00 |
| 99177 |
|
1,871 |
1,775 |
$0.00 |
| 1159F |
|
5,291 |
4,764 |
$0.00 |
| 99173 |
|
464 |
439 |
$0.00 |
| 90700 |
|
25 |
25 |
$0.00 |
| 90734 |
|
115 |
113 |
$0.00 |
| 1158F |
|
384 |
346 |
$0.00 |
| 3077F |
|
76 |
69 |
$0.00 |
| 1100F |
|
44 |
43 |
$0.00 |
| 90681 |
|
28 |
28 |
$0.00 |
| 3288F |
|
32 |
32 |
$0.00 |
| 2022F |
|
12 |
12 |
$0.00 |