| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,276 |
7,414 |
$676K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,550 |
8,144 |
$631K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,755 |
2,279 |
$238K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
720 |
678 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
840 |
701 |
$58K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
418 |
353 |
$36K |
| 99201 |
|
396 |
382 |
$33K |
| 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 |
2,918 |
2,609 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
193 |
157 |
$15K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
179 |
144 |
$15K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
163 |
140 |
$15K |
| 81002 |
|
2,626 |
1,678 |
$14K |
| 90832 |
Psychotherapy, 30 minutes with patient |
232 |
153 |
$12K |
| D0999 |
Unspecified diagnostic procedure, by report |
287 |
248 |
$10K |
| D1120 |
Prophylaxis - child |
87 |
75 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
730 |
581 |
$8K |
| 90834 |
Psychotherapy, 45 minutes with patient |
84 |
62 |
$6K |
| 59426 |
|
76 |
36 |
$6K |
| 99384 |
|
55 |
43 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
53 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
65 |
$5K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
3,394 |
3,072 |
$4K |
| 59425 |
|
42 |
29 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
74 |
57 |
$3K |
| D1351 |
Sealant - per tooth |
45 |
15 |
$2K |
| 92551 |
|
2,227 |
1,975 |
$1K |
| 99000 |
|
4,851 |
3,653 |
$1K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
78 |
78 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
561 |
472 |
$873.41 |
| 99173 |
|
2,731 |
2,384 |
$857.48 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
318 |
278 |
$750.35 |
| 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 |
20 |
19 |
$624.40 |
| 81025 |
|
677 |
551 |
$495.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,115 |
953 |
$476.50 |
| 85018 |
|
787 |
676 |
$435.32 |
| 0001A |
|
12 |
12 |
$340.11 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
125 |
101 |
$294.74 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
363 |
278 |
$170.83 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
744 |
627 |
$170.03 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
1,159 |
902 |
$149.59 |
| 0002A |
|
25 |
24 |
$114.14 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
362 |
350 |
$112.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
74 |
$108.83 |
| 0031A |
|
14 |
14 |
$35.02 |
| 90686 |
|
32 |
28 |
$0.00 |
| 0011A |
|
68 |
68 |
$0.00 |
| 91301 |
|
27 |
27 |
$0.00 |
| 0134A |
|
16 |
12 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
26 |
$0.00 |
| 0012A |
|
28 |
28 |
$0.00 |
| 86580 |
|
19 |
13 |
$0.00 |
| 91307 |
|
14 |
14 |
$0.00 |
| 90674 |
|
51 |
41 |
$0.00 |
| 90461 |
|
312 |
268 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
188 |
148 |
$0.00 |
| 91313 |
|
40 |
27 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
72 |
68 |
$0.00 |
| 91300 |
|
46 |
41 |
$0.00 |
| 90670 |
|
31 |
31 |
$0.00 |
| 90633 |
|
16 |
14 |
$0.00 |
| 91322 |
|
114 |
109 |
$0.00 |
| 82948 |
|
98 |
72 |
$0.00 |
| 91312 |
|
47 |
35 |
$0.00 |
| 90715 |
|
51 |
45 |
$0.00 |
| 0003A |
|
12 |
12 |
$0.00 |
| 90671 |
|
18 |
16 |
$0.00 |