| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
57,264 |
36,704 |
$9.21M |
| D0999 |
Unspecified diagnostic procedure, by report |
4,468 |
3,631 |
$889K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30,368 |
20,009 |
$718K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,605 |
6,087 |
$226K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
5,050 |
3,786 |
$209K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,749 |
7,044 |
$156K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,433 |
2,974 |
$136K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,137 |
1,804 |
$71K |
| 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 |
2,523 |
2,084 |
$70K |
| 0001A |
|
242 |
149 |
$5K |
| 0012A |
|
596 |
560 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
268 |
227 |
$5K |
| 0002A |
|
202 |
132 |
$5K |
| G0402 |
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
234 |
176 |
$4K |
| 90686 |
|
3,359 |
3,212 |
$4K |
| 0011A |
|
672 |
607 |
$3K |
| 0072A |
|
111 |
71 |
$3K |
| 0031A |
|
137 |
118 |
$2K |
| U0004 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r |
203 |
147 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
699 |
613 |
$1K |
| 0071A |
|
43 |
29 |
$1K |
| 90621 |
|
556 |
504 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
362 |
310 |
$821.28 |
| 90651 |
|
747 |
713 |
$756.90 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
181 |
179 |
$463.98 |
| D0120 |
Periodic oral evaluation - established patient |
1,926 |
1,886 |
$141.40 |
| D1110 |
Prophylaxis - adult |
592 |
579 |
$109.76 |
| D0272 |
Bitewings - two radiographic images |
1,545 |
1,505 |
$93.52 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,852 |
1,813 |
$88.20 |
| D1351 |
Sealant - per tooth |
2,459 |
611 |
$84.72 |
| D1120 |
Prophylaxis - child |
1,103 |
1,083 |
$73.50 |
| D0220 |
Intraoral - periapical first radiographic image |
1,818 |
1,780 |
$62.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,802 |
1,765 |
$57.55 |
| D1330 |
|
1,816 |
1,774 |
$12.25 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
44 |
41 |
$8.16 |
| 91300 |
|
144 |
130 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
44 |
$0.00 |
| D0330 |
Panoramic radiographic image |
206 |
198 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
78 |
77 |
$0.00 |
| 90461 |
|
25 |
20 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
141 |
140 |
$0.00 |
| D0602 |
|
2,239 |
2,203 |
$0.00 |
| 90677 |
|
111 |
95 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
94 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
460 |
428 |
$0.00 |
| D0601 |
|
55 |
52 |
$0.00 |
| 91301 |
|
84 |
78 |
$0.00 |
| 91307 |
|
113 |
107 |
$0.00 |
| 91303 |
|
22 |
18 |
$0.00 |