| 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 |
4,443 |
3,941 |
$285K |
| D1110 |
Prophylaxis - adult |
1,463 |
1,458 |
$108K |
| D1120 |
Prophylaxis - child |
2,373 |
2,370 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
1,201 |
1,188 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,444 |
2,437 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
541 |
463 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,592 |
2,588 |
$65K |
| 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 |
915 |
888 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
876 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
410 |
238 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,096 |
2,061 |
$30K |
| D0274 |
Bitewings - four radiographic images |
879 |
877 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,670 |
1,173 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
108 |
67 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
177 |
$20K |
| D0272 |
Bitewings - two radiographic images |
560 |
559 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
52 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
361 |
356 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,707 |
2,500 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
34 |
$7K |
| 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 |
95 |
82 |
$6K |
| D1351 |
Sealant - per tooth |
133 |
43 |
$4K |
| D7230 |
|
22 |
19 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
151 |
136 |
$2K |
| 99386 |
|
62 |
61 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
493 |
490 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
96 |
84 |
$2K |
| 99385 |
|
101 |
101 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
333 |
323 |
$1K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$880.09 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
27 |
$444.50 |
| 90834 |
Psychotherapy, 45 minutes with patient |
47 |
44 |
$311.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
252 |
246 |
$307.28 |
| 90756 |
|
36 |
36 |
$177.96 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
55 |
34 |
$105.00 |
| 36415 |
Collection of venous blood by venipuncture |
74 |
71 |
$62.10 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
299 |
293 |
$56.28 |
| 90674 |
|
45 |
43 |
$46.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
14 |
14 |
$42.48 |
| 82962 |
|
448 |
423 |
$35.23 |
| 81025 |
|
25 |
24 |
$14.00 |
| 81000 |
|
34 |
32 |
$3.33 |
| 81001 |
|
12 |
12 |
$2.92 |
| 0001F |
|
4,359 |
3,952 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
302 |
296 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
160 |
159 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
14 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
13 |
12 |
$0.00 |