| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,242 |
21,927 |
$736K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,125 |
6,047 |
$170K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,000 |
3,236 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,205 |
3,990 |
$114K |
| 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 |
13,176 |
5,594 |
$81K |
| D1120 |
Prophylaxis - child |
1,188 |
1,103 |
$47K |
| D9110 |
|
1,137 |
1,041 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,589 |
1,474 |
$17K |
| D1110 |
Prophylaxis - adult |
334 |
310 |
$14K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
2,875 |
1,343 |
$12K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
524 |
481 |
$7K |
| D1351 |
Sealant - per tooth |
401 |
132 |
$6K |
| D0274 |
Bitewings - four radiographic images |
214 |
201 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
430 |
411 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
906 |
825 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
2,941 |
2,487 |
$5K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
358 |
337 |
$4K |
| 90688 |
|
270 |
263 |
$4K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
975 |
842 |
$4K |
| 90686 |
|
205 |
200 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
129 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
48 |
40 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
258 |
$3K |
| 99441 |
|
255 |
199 |
$3K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
69 |
69 |
$2K |
| 80061 |
Lipid panel |
215 |
202 |
$2K |
| 90674 |
|
94 |
88 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
108 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
61 |
61 |
$2K |
| D0190 |
|
67 |
62 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
13 |
$954.27 |
| 0011A |
|
25 |
25 |
$830.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
23 |
14 |
$585.65 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$508.80 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
186 |
45 |
$494.11 |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
12 |
12 |
$484.47 |
| 0012A |
|
12 |
12 |
$440.00 |
| 0124A |
|
20 |
15 |
$400.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
40 |
40 |
$254.77 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$212.38 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
44 |
12 |
$201.88 |
| 3008F |
|
23,525 |
19,820 |
$110.29 |
| D0603 |
|
1,700 |
1,635 |
$28.50 |
| 3074F |
|
7,840 |
6,725 |
$26.69 |
| 3078F |
|
7,748 |
6,597 |
$24.25 |
| 36416 |
|
61 |
52 |
$4.90 |
| 3079F |
|
1,363 |
1,219 |
$4.05 |
| 3077F |
|
794 |
675 |
$1.41 |
| 3080F |
|
73 |
66 |
$0.43 |
| 3075F |
|
204 |
185 |
$0.40 |
| 1159F |
|
3,506 |
2,970 |
$0.00 |
| 1160F |
|
3,496 |
2,963 |
$0.00 |
| 99442 |
|
15 |
14 |
$0.00 |
| 1125F |
|
1,447 |
1,206 |
$0.00 |
| D0602 |
|
21 |
15 |
$0.00 |
| 1126F |
|
703 |
609 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
15 |
12 |
$0.00 |