| 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 |
110,421 |
87,542 |
$5.94M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
75,817 |
63,708 |
$894K |
| 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 |
5,827 |
5,789 |
$396K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,101 |
2,213 |
$390K |
| D0120 |
Periodic oral evaluation - established patient |
3,226 |
3,220 |
$369K |
| D1110 |
Prophylaxis - adult |
2,921 |
2,918 |
$344K |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
4,216 |
4,150 |
$249K |
| 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 |
4,422 |
3,685 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,129 |
2,123 |
$228K |
| D0140 |
Limited oral evaluation - problem focused |
1,982 |
1,942 |
$206K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
22,808 |
19,740 |
$163K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,985 |
6,583 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
667 |
562 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
514 |
478 |
$82K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,366 |
1,358 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
2,110 |
2,097 |
$47K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,060 |
3,043 |
$36K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,793 |
3,118 |
$33K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,560 |
1,550 |
$33K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,795 |
1,784 |
$32K |
| 90651 |
|
546 |
545 |
$23K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
950 |
936 |
$23K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,617 |
3,453 |
$23K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
855 |
853 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,332 |
1,329 |
$17K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
693 |
672 |
$13K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
805 |
803 |
$13K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
605 |
598 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,638 |
2,582 |
$12K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
3,885 |
3,099 |
$10K |
| G0469 |
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health 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 mental health visit |
171 |
171 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,745 |
2,702 |
$9K |
| 90688 |
|
1,207 |
1,192 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,375 |
2,135 |
$6K |
| 90791 |
Psychiatric diagnostic evaluation |
315 |
312 |
$6K |
| 81025 |
|
2,793 |
2,744 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
39 |
$6K |
| 90632 |
|
220 |
217 |
$6K |
| 90715 |
|
696 |
687 |
$5K |
| 90620 |
|
173 |
172 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
28 |
$5K |
| 99000 |
|
659 |
640 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
453 |
446 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
435 |
417 |
$4K |
| 91322 |
|
85 |
84 |
$4K |
| 81002 |
|
3,162 |
3,089 |
$3K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
607 |
603 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
574 |
569 |
$3K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,593 |
1,441 |
$3K |
| 90732 |
|
49 |
48 |
$3K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
597 |
593 |
$2K |
| 11721 |
|
335 |
334 |
$2K |
| D2330 |
|
15 |
12 |
$2K |
| 90480 |
|
101 |
100 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
275 |
272 |
$2K |
| 90707 |
|
310 |
309 |
$2K |
| 96156 |
|
163 |
159 |
$2K |
| 90670 |
|
473 |
470 |
$1K |
| 82962 |
|
1,339 |
1,265 |
$1K |
| 0064A |
|
52 |
52 |
$948.05 |
| 99215 |
Prolong outpt/office vis |
46 |
45 |
$946.71 |
| 90716 |
|
284 |
281 |
$836.00 |
| 90686 |
|
567 |
566 |
$798.58 |
| 90656 |
|
44 |
44 |
$581.10 |
| D2331 |
|
15 |
13 |
$566.25 |
| 90746 |
|
14 |
14 |
$536.48 |
| 90714 |
|
28 |
28 |
$371.17 |
| 11055 |
|
37 |
37 |
$320.34 |
| 99442 |
|
529 |
455 |
$303.41 |
| 99385 |
|
18 |
18 |
$298.11 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
57 |
57 |
$246.78 |
| 90734 |
|
149 |
149 |
$220.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
16 |
13 |
$116.88 |
| 99441 |
|
211 |
195 |
$111.74 |
| 99384 |
|
14 |
14 |
$99.37 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
16 |
16 |
$72.93 |
| 87210 |
|
32 |
32 |
$72.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
29 |
$61.35 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
12 |
12 |
$60.60 |
| 90474 |
|
23 |
23 |
$48.00 |
| 99443 |
|
69 |
52 |
$45.15 |
| 83655 |
|
15 |
15 |
$30.09 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
13 |
13 |
$28.50 |
| 3044F |
|
3,696 |
3,244 |
$0.00 |
| 3048F |
|
2,124 |
1,855 |
$0.00 |
| 3008F |
|
13,329 |
11,544 |
$0.00 |
| 3049F |
|
1,251 |
1,087 |
$0.00 |
| 3075F |
|
2,846 |
2,731 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
12 |
12 |
$0.00 |
| 90698 |
|
40 |
40 |
$0.00 |
| 90619 |
|
63 |
61 |
$0.00 |
| 3079F |
|
5,332 |
4,983 |
$0.00 |
| 3080F |
|
3,677 |
3,348 |
$0.00 |
| 3074F |
|
9,058 |
8,046 |
$0.00 |
| 1125F |
|
122 |
119 |
$0.00 |
| 90680 |
|
36 |
36 |
$0.00 |
| 3052F |
|
20 |
15 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
124 |
122 |
$0.00 |
| 1036F |
|
274 |
251 |
$0.00 |
| 90723 |
|
16 |
16 |
$0.00 |
| 90647 |
|
19 |
19 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
20 |
20 |
$0.00 |
| 1126F |
|
103 |
101 |
$0.00 |
| 3725F |
|
120 |
118 |
$0.00 |
| 90461 |
|
1,789 |
1,768 |
$0.00 |
| 1159F |
|
600 |
570 |
$0.00 |
| 3050F |
|
1,032 |
904 |
$0.00 |
| 90633 |
|
273 |
270 |
$0.00 |
| 3078F |
|
6,337 |
5,791 |
$0.00 |
| 3077F |
|
3,455 |
3,167 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
229 |
224 |
$0.00 |
| 3046F |
|
478 |
408 |
$0.00 |
| 3045F |
|
353 |
306 |
$0.00 |
| 90700 |
|
135 |
135 |
$0.00 |
| 3051F |
|
16 |
13 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
18 |
18 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 3511F |
|
13 |
13 |
$0.00 |
| 90713 |
|
41 |
41 |
$0.00 |
| 1160F |
|
564 |
534 |
$0.00 |
| 90687 |
|
42 |
42 |
$0.00 |
| 2028F |
|
12 |
12 |
$0.00 |