| 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 |
3,248 |
2,800 |
$192K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
559 |
$74K |
| D1110 |
Prophylaxis - adult |
466 |
452 |
$55K |
| 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 |
643 |
620 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
335 |
$44K |
| D4355 |
|
115 |
115 |
$17K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,618 |
1,439 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
193 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
924 |
870 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,371 |
1,273 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
438 |
301 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
840 |
697 |
$2K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| 81025 |
|
833 |
715 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
424 |
408 |
$2K |
| 81002 |
|
1,121 |
976 |
$857.17 |
| D0274 |
Bitewings - four radiographic images |
110 |
101 |
$676.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
162 |
160 |
$664.62 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
13 |
$592.47 |
| 81001 |
|
627 |
587 |
$501.66 |
| 83655 |
|
124 |
123 |
$484.02 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
72 |
70 |
$478.04 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
16 |
16 |
$436.74 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$424.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
40 |
$368.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$324.00 |
| 96127 |
|
270 |
264 |
$275.37 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
296 |
291 |
$257.60 |
| 83037 |
|
49 |
48 |
$87.27 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
13 |
13 |
$73.11 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
25 |
25 |
$63.00 |
| 99406 |
|
74 |
73 |
$41.60 |
| 90670 |
|
12 |
12 |
$0.01 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 87799 |
|
15 |
13 |
$0.00 |
| 90461 |
|
15 |
15 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
18 |
15 |
$0.00 |
| 90632 |
|
15 |
14 |
$0.00 |
| 86592 |
|
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
13 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
18 |
16 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
16 |
12 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
13 |
12 |
$0.00 |
| 90686 |
|
13 |
13 |
$0.00 |