| 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 |
20,629 |
17,643 |
$1.36M |
| D1110 |
Prophylaxis - adult |
4,961 |
4,948 |
$407K |
| 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 |
4,280 |
2,346 |
$285K |
| D0140 |
Limited oral evaluation - problem focused |
2,664 |
2,588 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,085 |
1,578 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,439 |
2,432 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
3,765 |
3,754 |
$169K |
| 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 |
1,898 |
1,882 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,424 |
745 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,216 |
880 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
438 |
379 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,936 |
1,915 |
$57K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,122 |
8,489 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,082 |
2,074 |
$39K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,067 |
7,335 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,431 |
4,372 |
$36K |
| D1120 |
Prophylaxis - child |
636 |
636 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,386 |
2,985 |
$17K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,670 |
1,102 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
650 |
$15K |
| D2331 |
|
124 |
81 |
$12K |
| D4355 |
|
91 |
91 |
$8K |
| D0330 |
Panoramic radiographic image |
348 |
348 |
$8K |
| 0012A |
|
192 |
192 |
$7K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,079 |
755 |
$7K |
| D4341 |
|
44 |
18 |
$6K |
| 90837 |
Psychotherapy, 53 minutes with patient |
471 |
332 |
$5K |
| 0011A |
|
193 |
193 |
$5K |
| 99000 |
|
717 |
681 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
744 |
695 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
271 |
269 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,112 |
1,062 |
$3K |
| 90674 |
|
379 |
375 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
770 |
713 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
277 |
268 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,408 |
1,381 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
180 |
170 |
$2K |
| 96127 |
|
4,107 |
4,001 |
$2K |
| 99407 |
|
281 |
263 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
142 |
142 |
$1K |
| 90661 |
|
42 |
42 |
$1K |
| 0064A |
|
42 |
42 |
$1K |
| 99406 |
|
339 |
317 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
222 |
218 |
$1K |
| 81003 |
|
2,222 |
2,145 |
$991.82 |
| 90632 |
|
56 |
55 |
$941.43 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
62 |
61 |
$914.94 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
314 |
287 |
$708.12 |
| 90686 |
|
76 |
70 |
$666.05 |
| 99385 |
|
56 |
55 |
$665.77 |
| D0180 |
|
12 |
12 |
$581.40 |
| D0270 |
|
140 |
139 |
$551.61 |
| 81025 |
|
359 |
332 |
$452.47 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$450.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$446.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
148 |
144 |
$411.40 |
| 96160 |
|
286 |
281 |
$186.64 |
| 93000 |
|
61 |
60 |
$161.67 |
| D0602 |
|
333 |
332 |
$150.00 |
| D0603 |
|
326 |
326 |
$150.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
82 |
71 |
$141.76 |
| D0601 |
|
280 |
280 |
$140.00 |
| 36415 |
Collection of venous blood by venipuncture |
138 |
137 |
$126.68 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
15 |
14 |
$111.85 |
| 90658 |
|
14 |
13 |
$90.96 |
| 36416 |
|
346 |
331 |
$79.58 |
| 80305 |
|
276 |
182 |
$52.15 |
| 94010 |
|
23 |
13 |
$48.87 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
140 |
136 |
$35.77 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
134 |
130 |
$28.35 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
13 |
13 |
$18.83 |
| 81002 |
|
12 |
12 |
$11.52 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
33 |
33 |
$11.50 |
| 3051F |
|
35 |
34 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| G9276 |
Documentation that patient is a current tobacco user |
230 |
221 |
$0.00 |
| 3085F |
|
279 |
278 |
$0.00 |
| 4001F |
|
42 |
40 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
29 |
29 |
$0.00 |
| 3016F |
|
18 |
18 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
896 |
881 |
$0.00 |
| 3044F |
|
384 |
380 |
$0.00 |
| 3008F |
|
657 |
616 |
$0.00 |
| 3011F |
|
12 |
12 |
$0.00 |
| 92227 |
|
12 |
12 |
$0.00 |
| 2000F |
|
29 |
28 |
$0.00 |