| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
21,733 |
18,759 |
$1.16M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,148 |
3,568 |
$597K |
| D1110 |
Prophylaxis - adult |
4,091 |
4,086 |
$329K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
5,485 |
3,421 |
$291K |
| D0140 |
Limited oral evaluation - problem focused |
4,424 |
4,359 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,802 |
1,528 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,606 |
2,603 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
5,339 |
5,334 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,583 |
1,250 |
$156K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,979 |
10,751 |
$125K |
| D1120 |
Prophylaxis - child |
2,261 |
2,260 |
$87K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,348 |
5,010 |
$73K |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
1,061 |
1,052 |
$71K |
| 90837 |
Psychotherapy, 53 minutes with patient |
3,067 |
1,952 |
$70K |
| D1206 |
Topical application of fluoride varnish |
2,548 |
2,547 |
$60K |
| D0330 |
Panoramic radiographic image |
1,884 |
1,880 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,654 |
1,595 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
5,398 |
5,286 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,297 |
2,294 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
227 |
$38K |
| D1354 |
|
1,656 |
539 |
$30K |
| D2331 |
|
254 |
214 |
$27K |
| D2330 |
|
168 |
127 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,706 |
1,612 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
63 |
$11K |
| 90832 |
Psychotherapy, 30 minutes with patient |
755 |
598 |
$8K |
| D0272 |
Bitewings - two radiographic images |
400 |
399 |
$8K |
| D2335 |
|
47 |
37 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,840 |
1,065 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
438 |
390 |
$7K |
| D2332 |
|
39 |
36 |
$5K |
| 99215 |
Prolong outpt/office vis |
213 |
200 |
$5K |
| 80306 |
|
930 |
756 |
$3K |
| D4355 |
|
24 |
24 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
540 |
518 |
$2K |
| 90688 |
|
413 |
411 |
$2K |
| 87428 |
|
227 |
222 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
62 |
61 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
102 |
101 |
$2K |
| G0008 |
Administration of influenza virus vaccine |
435 |
433 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
166 |
163 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
68 |
68 |
$957.36 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
242 |
240 |
$666.37 |
| 0012A |
|
15 |
15 |
$567.75 |
| 0011A |
|
22 |
22 |
$513.12 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
36 |
36 |
$505.00 |
| 99000 |
|
41 |
40 |
$502.32 |
| D0270 |
|
38 |
38 |
$360.58 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
29 |
$336.42 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
97 |
95 |
$294.20 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
56 |
55 |
$265.69 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
92 |
92 |
$259.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$212.15 |
| 81002 |
|
254 |
241 |
$187.16 |
| 96160 |
|
182 |
180 |
$158.18 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
59 |
55 |
$112.89 |
| 71046 |
Radiologic examination, chest; 2 views |
14 |
14 |
$65.40 |
| 36415 |
Collection of venous blood by venipuncture |
37 |
37 |
$29.58 |
| D0603 |
|
147 |
147 |
$0.00 |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
3,086 |
2,695 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |
| 91301 |
|
21 |
21 |
$0.00 |
| 90461 |
|
15 |
15 |
$0.00 |