| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
112,745 |
97,352 |
$21.92M |
| 99499 |
|
2,167 |
1,966 |
$17K |
| 0012A |
|
272 |
272 |
$10K |
| 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 |
488 |
451 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,146 |
16,393 |
$8K |
| 0011A |
|
231 |
231 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,843 |
7,125 |
$7K |
| 3725F |
|
1,265 |
1,226 |
$5K |
| 3079F |
|
960 |
895 |
$4K |
| 3077F |
|
818 |
763 |
$4K |
| 3074F |
|
1,267 |
1,149 |
$3K |
| 0002A |
|
69 |
69 |
$3K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
721 |
567 |
$2K |
| 3078F |
|
846 |
764 |
$2K |
| D5899 |
|
2,504 |
2,191 |
$2K |
| 0064A |
|
47 |
47 |
$2K |
| 3075F |
|
345 |
330 |
$1K |
| 0072A |
|
34 |
34 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,295 |
2,991 |
$1K |
| 3080F |
|
405 |
379 |
$954.44 |
| 0001A |
|
25 |
25 |
$920.00 |
| 0071A |
|
20 |
20 |
$680.00 |
| D0210 |
Intraoral - complete series of radiographic images |
4,012 |
3,996 |
$564.36 |
| D0120 |
Periodic oral evaluation - established patient |
15,419 |
15,375 |
$539.40 |
| D7140 |
Extraction, erupted tooth or exposed root |
2,272 |
1,457 |
$510.36 |
| D0274 |
Bitewings - four radiographic images |
10,127 |
10,098 |
$476.28 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,871 |
5,855 |
$453.60 |
| 81025 |
|
1,963 |
1,871 |
$349.94 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
628 |
445 |
$317.42 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,426 |
1,361 |
$284.71 |
| D0220 |
Intraoral - periapical first radiographic image |
16,576 |
16,391 |
$264.60 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,222 |
3,517 |
$259.90 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,830 |
2,771 |
$255.18 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
379 |
367 |
$238.84 |
| D9110 |
|
2,076 |
2,038 |
$226.80 |
| D2331 |
|
374 |
320 |
$207.92 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,783 |
13,545 |
$173.88 |
| 92551 |
|
1,836 |
1,789 |
$151.57 |
| D0140 |
Limited oral evaluation - problem focused |
3,017 |
2,953 |
$132.30 |
| 99173 |
|
2,239 |
2,162 |
$117.72 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
593 |
474 |
$77.89 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
130 |
121 |
$72.00 |
| 80061 |
Lipid panel |
1,367 |
1,199 |
$70.00 |
| D1206 |
Topical application of fluoride varnish |
6,483 |
6,464 |
$68.04 |
| D1120 |
Prophylaxis - child |
4,912 |
4,910 |
$62.37 |
| D0272 |
Bitewings - two radiographic images |
2,601 |
2,600 |
$60.48 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
980 |
920 |
$56.70 |
| 90686 |
|
901 |
891 |
$54.70 |
| 3044F |
|
13 |
13 |
$50.00 |
| D1110 |
Prophylaxis - adult |
10,130 |
10,121 |
$40.80 |
| D0145 |
Oral evaluation for a patient under three years of age |
926 |
926 |
$37.80 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,033 |
995 |
$28.35 |
| D0601 |
|
3,420 |
3,408 |
$25.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
230 |
225 |
$20.00 |
| 0502F |
|
12 |
12 |
$20.00 |
| D1330 |
|
15,448 |
15,302 |
$20.00 |
| D0603 |
|
6,474 |
6,457 |
$10.00 |
| D0602 |
|
3,434 |
3,430 |
$5.00 |
| D1310 |
|
5,050 |
4,972 |
$5.00 |
| 82962 |
|
141 |
121 |
$2.00 |
| D4341 |
|
142 |
80 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
338 |
328 |
$0.00 |
| 90715 |
|
54 |
54 |
$0.00 |
| 1159F |
|
425 |
379 |
$0.00 |
| 11721 |
|
141 |
136 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
284 |
272 |
$0.00 |
| 1160F |
|
425 |
379 |
$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 |
718 |
686 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
65 |
40 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
146 |
$0.00 |
| D0330 |
Panoramic radiographic image |
611 |
610 |
$0.00 |
| 4004F |
|
51 |
51 |
$0.00 |
| 87210 |
|
12 |
12 |
$0.00 |
| 90734 |
|
72 |
72 |
$0.00 |
| D0270 |
|
100 |
99 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
29 |
24 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
226 |
223 |
$0.00 |
| 80305 |
|
29 |
26 |
$0.00 |
| D2332 |
|
50 |
41 |
$0.00 |
| D0180 |
|
34 |
34 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
37 |
$0.00 |
| 90461 |
|
28 |
27 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
12 |
12 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 99201 |
|
54 |
53 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,589 |
2,588 |
$0.00 |
| D1351 |
Sealant - per tooth |
4,196 |
920 |
$0.00 |
| 88142 |
|
165 |
160 |
$0.00 |
| D9995 |
|
66 |
66 |
$0.00 |
| 3008F |
|
840 |
731 |
$0.00 |
| 1036F |
|
89 |
81 |
$0.00 |
| D2330 |
|
414 |
303 |
$0.00 |
| 1125F |
|
247 |
218 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
151 |
139 |
$0.00 |
| 90656 |
|
21 |
21 |
$0.00 |
| 1126F |
|
212 |
189 |
$0.00 |
| 91301 |
|
51 |
51 |
$0.00 |
| D2335 |
|
46 |
43 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
13 |
$0.00 |
| D1320 |
|
29 |
28 |
$0.00 |
| 81000 |
|
13 |
13 |
$0.00 |
| 86580 |
|
13 |
13 |
$0.00 |
| 90651 |
|
73 |
72 |
$0.00 |
| 1031F |
|
120 |
112 |
$0.00 |
| 91307 |
|
14 |
13 |
$0.00 |
| 90688 |
|
28 |
28 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
16 |
$0.00 |
| 1111F |
|
33 |
25 |
$0.00 |