| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,477 |
1,376 |
$59K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
51 |
46 |
$58K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
1,222 |
542 |
$46K |
| D1110 |
Prophylaxis - adult |
1,243 |
1,082 |
$37K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,649 |
834 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,466 |
1,350 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
371 |
357 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
993 |
858 |
$22K |
| 97803 |
|
1,939 |
1,443 |
$21K |
| 97802 |
|
788 |
618 |
$17K |
| 90832 |
Psychotherapy, 30 minutes with patient |
282 |
234 |
$12K |
| D1120 |
Prophylaxis - child |
486 |
459 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,300 |
1,142 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
615 |
603 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
68 |
$8K |
| 92508 |
Group treatment of speech, language, voice, communication, and/or auditory processing disorder |
415 |
219 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
98 |
98 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
101 |
$6K |
| D0330 |
Panoramic radiographic image |
140 |
123 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,507 |
1,267 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
86 |
80 |
$5K |
| 90686 |
|
528 |
507 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
78 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,122 |
527 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
170 |
164 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
49 |
49 |
$3K |
| D0274 |
Bitewings - four radiographic images |
205 |
184 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
121 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
23 |
21 |
$2K |
| D1206 |
Topical application of fluoride varnish |
142 |
108 |
$2K |
| 92523 |
|
16 |
16 |
$2K |
| 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 |
64 |
57 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
31 |
$2K |
| 90651 |
|
193 |
189 |
$1K |
| 90715 |
|
50 |
49 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
65 |
58 |
$856.01 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
143 |
109 |
$845.60 |
| 93000 |
|
44 |
44 |
$689.30 |
| 92551 |
|
88 |
88 |
$543.88 |
| 85018 |
|
213 |
208 |
$519.12 |
| 90734 |
|
107 |
105 |
$458.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$380.92 |
| 90670 |
|
79 |
72 |
$326.87 |
| 90744 |
|
92 |
85 |
$289.18 |
| 80305 |
|
55 |
50 |
$280.47 |
| 90633 |
|
171 |
168 |
$263.25 |
| 90710 |
|
61 |
60 |
$201.75 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
22 |
22 |
$136.36 |
| 90621 |
|
28 |
28 |
$104.50 |
| 82962 |
|
39 |
37 |
$90.73 |
| 81025 |
|
13 |
12 |
$85.49 |
| 90685 |
|
17 |
17 |
$55.75 |
| 99173 |
|
15 |
15 |
$37.44 |
| 90698 |
|
14 |
12 |
$30.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
236 |
195 |
$0.00 |
| 3078F |
|
128 |
106 |
$0.00 |
| 90461 |
|
54 |
41 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
90 |
90 |
$0.00 |
| 2001F |
|
260 |
214 |
$0.00 |
| 3008F |
|
261 |
214 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
252 |
208 |
$0.00 |
| 3074F |
|
177 |
148 |
$0.00 |
| 1036F |
|
19 |
16 |
$0.00 |
| 3079F |
|
73 |
62 |
$0.00 |
| 3075F |
|
36 |
33 |
$0.00 |