| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87428 |
|
2,785 |
2,421 |
$67K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,941 |
2,694 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
398 |
227 |
$31K |
| D1110 |
Prophylaxis - adult |
724 |
646 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
143 |
$22K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
703 |
685 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
798 |
687 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
381 |
$15K |
| D1206 |
Topical application of fluoride varnish |
845 |
733 |
$13K |
| D1120 |
Prophylaxis - child |
420 |
361 |
$12K |
| D0330 |
Panoramic radiographic image |
230 |
200 |
$12K |
| 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 |
1,560 |
1,295 |
$11K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
653 |
336 |
$10K |
| D0274 |
Bitewings - four radiographic images |
402 |
353 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
82 |
$9K |
| T1015 |
Clinic visit/encounter, all-inclusive |
627 |
481 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
300 |
$5K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
542 |
447 |
$5K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
281 |
104 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
59 |
$4K |
| 90832 |
Psychotherapy, 30 minutes with patient |
145 |
55 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
301 |
272 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
174 |
171 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
65 |
$3K |
| 80053 |
Comprehensive metabolic panel |
171 |
160 |
$2K |
| D0272 |
Bitewings - two radiographic images |
67 |
64 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
535 |
453 |
$1K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
122 |
109 |
$966.49 |
| 85027 |
|
130 |
120 |
$775.88 |
| 99607 |
|
63 |
50 |
$710.00 |
| 99605 |
|
12 |
12 |
$600.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
28 |
25 |
$420.00 |
| 80061 |
Lipid panel |
28 |
25 |
$342.51 |
| 81003 |
|
242 |
214 |
$275.08 |
| 83655 |
|
14 |
13 |
$155.87 |
| 85018 |
|
12 |
12 |
$28.44 |
| 90656 |
|
144 |
141 |
$22.01 |
| 99307 |
|
79 |
79 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
51 |
51 |
$0.00 |