| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,275 |
3,131 |
$192K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,230 |
1,217 |
$94K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,153 |
1,122 |
$89K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,541 |
1,498 |
$57K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
530 |
516 |
$44K |
| 92551 |
|
2,950 |
2,900 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
280 |
270 |
$19K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
235 |
214 |
$16K |
| 85018 |
|
4,803 |
4,714 |
$10K |
| 81002 |
|
3,226 |
3,161 |
$9K |
| 99173 |
|
2,950 |
2,898 |
$6K |
| 90686 |
|
529 |
520 |
$6K |
| 90649 |
|
166 |
162 |
$4K |
| 90670 |
|
359 |
335 |
$4K |
| 90674 |
|
227 |
225 |
$4K |
| 90756 |
|
153 |
153 |
$3K |
| 99188 |
|
227 |
221 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
489 |
477 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,076 |
4,891 |
$3K |
| 90734 |
|
179 |
175 |
$2K |
| 90688 |
|
146 |
144 |
$2K |
| 90633 |
|
151 |
144 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$1K |
| 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 |
177 |
160 |
$1K |
| 99383 |
|
13 |
13 |
$1K |
| 90656 |
|
59 |
59 |
$859.49 |
| 90710 |
|
77 |
77 |
$847.00 |
| D0274 |
Bitewings - four radiographic images |
64 |
64 |
$828.00 |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$809.85 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$703.77 |
| 36415 |
Collection of venous blood by venipuncture |
646 |
617 |
$656.11 |
| 96127 |
|
114 |
114 |
$551.19 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,061 |
2,506 |
$522.43 |
| 90715 |
|
33 |
30 |
$367.00 |
| 90620 |
|
27 |
27 |
$306.00 |
| 99441 |
|
17 |
17 |
$288.00 |
| 90647 |
|
26 |
25 |
$253.00 |
| 90696 |
|
19 |
19 |
$209.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$207.90 |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
24 |
$207.00 |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
76 |
$156.52 |
| 90661 |
|
13 |
13 |
$143.00 |
| 90698 |
|
15 |
13 |
$132.00 |
| 90716 |
|
13 |
12 |
$121.00 |
| 90689 |
|
62 |
59 |
$85.00 |
| 82947 |
|
14 |
14 |
$39.30 |
| 99000 |
|
13 |
12 |
$7.58 |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
67 |
$0.00 |