| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90671 |
|
553 |
305 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,694 |
15,697 |
$16K |
| 90832 |
Psychotherapy, 30 minutes with patient |
327 |
258 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,923 |
1,645 |
$9K |
| D1110 |
Prophylaxis - adult |
242 |
217 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
132 |
125 |
$5K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,735 |
968 |
$4K |
| 99497 |
|
14,233 |
13,278 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
157 |
$4K |
| 90686 |
|
849 |
474 |
$3K |
| D0272 |
Bitewings - two radiographic images |
214 |
194 |
$3K |
| 97802 |
|
220 |
205 |
$3K |
| 90651 |
|
670 |
370 |
$3K |
| D0330 |
Panoramic radiographic image |
73 |
69 |
$2K |
| 90733 |
|
518 |
282 |
$2K |
| 90620 |
|
358 |
198 |
$2K |
| 90715 |
|
222 |
123 |
$1K |
| 97803 |
|
95 |
84 |
$999.92 |
| D0120 |
Periodic oral evaluation - established patient |
66 |
47 |
$997.88 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
171 |
122 |
$989.52 |
| 0124A |
|
29 |
14 |
$960.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
167 |
125 |
$805.50 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$780.48 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,084 |
2,973 |
$648.75 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
512 |
279 |
$639.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
36 |
$622.86 |
| 90461 |
|
253 |
135 |
$530.75 |
| 99402 |
|
1,322 |
1,149 |
$490.56 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
230 |
222 |
$450.00 |
| 90716 |
|
386 |
213 |
$349.20 |
| 90677 |
|
24 |
15 |
$288.66 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$260.00 |
| 90670 |
|
68 |
36 |
$193.49 |
| 99442 |
|
435 |
344 |
$164.43 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
213 |
202 |
$127.56 |
| 90707 |
|
356 |
197 |
$116.50 |
| 90736 |
|
36 |
23 |
$102.00 |
| 96127 |
|
2,190 |
1,974 |
$53.40 |
| 93793 |
|
134 |
131 |
$25.77 |
| 88142 |
|
510 |
504 |
$20.26 |
| 90633 |
|
410 |
232 |
$6.00 |
| 96160 |
|
4,731 |
4,097 |
$2.23 |
| 99409 |
|
10,588 |
9,847 |
$0.06 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
286 |
264 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
617 |
592 |
$0.00 |
| 1159F |
|
14,255 |
12,657 |
$0.00 |
| 84439 |
|
301 |
255 |
$0.00 |
| 1160F |
|
12,887 |
11,692 |
$0.00 |
| 3078F |
|
14,732 |
13,441 |
$0.00 |
| 3288F |
|
1,273 |
1,234 |
$0.00 |
| 3077F |
|
2,331 |
2,236 |
$0.00 |
| 99408 |
|
5,715 |
5,317 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
524 |
418 |
$0.00 |
| 3725F |
|
16,774 |
15,516 |
$0.00 |
| 99401 |
|
4,925 |
2,939 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
210 |
163 |
$0.00 |
| 86703 |
|
361 |
334 |
$0.00 |
| 1158F |
|
968 |
955 |
$0.00 |
| 80061 |
Lipid panel |
1,604 |
1,466 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
64 |
63 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
61 |
50 |
$0.00 |
| 2028F |
|
499 |
488 |
$0.00 |
| 99397 |
|
83 |
83 |
$0.00 |
| 84155 |
|
28 |
24 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
328 |
246 |
$0.00 |
| 84550 |
|
59 |
54 |
$0.00 |
| G9316 |
Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family |
457 |
453 |
$0.00 |
| 3015F |
|
46 |
31 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
29 |
26 |
$0.00 |
| 1090F |
|
83 |
80 |
$0.00 |
| 88313 |
|
218 |
183 |
$0.00 |
| 90648 |
|
173 |
96 |
$0.00 |
| 98960 |
|
24 |
24 |
$0.00 |
| 82570 |
|
40 |
36 |
$0.00 |
| 1124F |
|
27 |
27 |
$0.00 |
| 71046 |
Radiologic examination, chest; 2 views |
15 |
15 |
$0.00 |
| 90750 |
|
37 |
26 |
$0.00 |
| 3051F |
|
15 |
13 |
$0.00 |
| 90621 |
|
31 |
12 |
$0.00 |
| 0521F |
|
16 |
16 |
$0.00 |
| 90700 |
|
44 |
27 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
14 |
13 |
$0.00 |
| 99173 |
|
19 |
19 |
$0.00 |
| 2000F |
|
15,874 |
14,440 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
798 |
756 |
$0.00 |
| 1126F |
|
18,302 |
16,711 |
$0.00 |
| G9226 |
Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
470 |
460 |
$0.00 |
| 1000F |
|
13,560 |
12,486 |
$0.00 |
| 4000F |
|
6,174 |
5,775 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,607 |
1,474 |
$0.00 |
| 3075F |
|
2,544 |
2,441 |
$0.00 |
| 3079F |
|
4,649 |
4,405 |
$0.00 |
| 3074F |
|
13,926 |
12,623 |
$0.00 |
| 1125F |
|
3,730 |
3,504 |
$0.00 |
| 3008F |
|
21,251 |
19,204 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,501 |
1,355 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
1,501 |
1,382 |
$0.00 |
| 1220F |
|
12,878 |
11,958 |
$0.00 |
| 81001 |
|
1,538 |
1,402 |
$0.00 |
| 3044F |
|
1,633 |
1,563 |
$0.00 |
| 2001F |
|
19,520 |
17,471 |
$0.00 |
| 96112 |
|
13 |
13 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
782 |
604 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
1,058 |
1,013 |
$0.00 |
| 90697 |
|
80 |
42 |
$0.00 |
| 1170F |
|
1,962 |
1,873 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,245 |
1,149 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
286 |
264 |
$0.00 |
| 88364 |
|
143 |
143 |
$0.00 |
| 82043 |
|
169 |
168 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
286 |
282 |
$0.00 |
| 1123F |
|
4,964 |
4,493 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
499 |
456 |
$0.00 |
| 85027 |
|
338 |
295 |
$0.00 |
| 86710 |
|
56 |
52 |
$0.00 |
| 1101F |
|
1,141 |
1,107 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
85 |
82 |
$0.00 |
| 81000 |
|
28 |
24 |
$0.00 |
| 99050 |
|
90 |
84 |
$0.00 |
| 3048F |
|
110 |
102 |
$0.00 |
| 86803 |
|
356 |
337 |
$0.00 |
| 90744 |
|
22 |
12 |
$0.00 |
| 90698 |
|
77 |
45 |
$0.00 |
| 94010 |
|
93 |
79 |
$0.00 |
| 90723 |
|
43 |
25 |
$0.00 |
| 3017F |
|
12 |
12 |
$0.00 |
| 90619 |
|
24 |
13 |
$0.00 |
| 90696 |
|
69 |
39 |
$0.00 |
| 3049F |
|
58 |
46 |
$0.00 |
| 80069 |
|
47 |
42 |
$0.00 |
| 86738 |
|
55 |
52 |
$0.00 |
| 3011F |
|
29 |
29 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
36 |
36 |
$0.00 |
| D1330 |
|
122 |
121 |
$0.00 |
| 86592 |
|
37 |
28 |
$0.00 |
| 82962 |
|
12 |
12 |
$0.00 |
| 3080F |
|
24 |
24 |
$0.00 |
| 84153 |
|
13 |
13 |
$0.00 |
| 86580 |
|
56 |
54 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
16 |
16 |
$0.00 |
| 96161 |
|
24 |
19 |
$0.00 |
| 82607 |
|
24 |
24 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
19 |
19 |
$0.00 |