| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
37,505 |
24,543 |
$3.25M |
| 90832 |
Psychotherapy, 30 minutes with patient |
12,997 |
6,705 |
$726K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,276 |
1,097 |
$140K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,155 |
1,128 |
$138K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,116 |
1,089 |
$137K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,707 |
935 |
$119K |
| 99441 |
|
1,297 |
1,170 |
$117K |
| D1110 |
Prophylaxis - adult |
3,305 |
1,585 |
$88K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
699 |
575 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,371 |
885 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
4,686 |
1,372 |
$61K |
| 99442 |
|
611 |
559 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,274 |
665 |
$44K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,212 |
2,201 |
$43K |
| 99443 |
|
542 |
439 |
$35K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
288 |
215 |
$30K |
| G0008 |
Administration of influenza virus vaccine |
1,548 |
1,548 |
$28K |
| 90791 |
Psychiatric diagnostic evaluation |
194 |
166 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
911 |
465 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
348 |
266 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,294 |
747 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
180 |
$15K |
| G0009 |
Administration of pneumococcal vaccine |
769 |
767 |
$14K |
| 90834 |
Psychotherapy, 45 minutes with patient |
102 |
95 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
863 |
818 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
69 |
37 |
$5K |
| T2022 |
Case management, per month |
59 |
42 |
$5K |
| D0330 |
Panoramic radiographic image |
183 |
81 |
$4K |
| D1310 |
|
317 |
151 |
$3K |
| 99381 |
|
13 |
13 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
126 |
126 |
$2K |
| 97803 |
|
28 |
26 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
253 |
250 |
$945.10 |
| 97802 |
|
25 |
25 |
$930.00 |
| D0220 |
Intraoral - periapical first radiographic image |
231 |
231 |
$860.19 |
| D1120 |
Prophylaxis - child |
97 |
93 |
$770.39 |
| 0071A |
|
18 |
18 |
$720.00 |
| 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 |
29 |
14 |
$703.16 |
| 85018 |
|
345 |
344 |
$686.00 |
| 87254 |
|
72 |
71 |
$490.78 |
| 92551 |
|
1,553 |
1,552 |
$284.45 |
| 94760 |
|
2,150 |
2,091 |
$244.78 |
| 0011A |
|
31 |
31 |
$218.27 |
| 88720 |
|
34 |
14 |
$170.68 |
| 0012A |
|
19 |
19 |
$92.21 |
| D0270 |
|
12 |
12 |
$38.01 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$33.00 |
| 99173 |
|
1,763 |
1,762 |
$19.03 |
| 81025 |
|
32 |
29 |
$0.00 |
| D1330 |
|
546 |
546 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |