| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29,609 |
16,260 |
$1.62M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,985 |
4,393 |
$453K |
| 36415 |
Collection of venous blood by venipuncture |
15,572 |
5,630 |
$375K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,172 |
2,815 |
$272K |
| 99215 |
Prolong outpt/office vis |
4,354 |
1,671 |
$185K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,591 |
916 |
$154K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,367 |
772 |
$133K |
| D1110 |
Prophylaxis - adult |
3,393 |
1,442 |
$87K |
| 11721 |
|
1,945 |
1,556 |
$55K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
2,095 |
437 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,910 |
1,559 |
$28K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
468 |
223 |
$28K |
| 99441 |
|
362 |
291 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
656 |
629 |
$23K |
| D1120 |
Prophylaxis - child |
908 |
359 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
397 |
189 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
929 |
925 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
901 |
894 |
$18K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,068 |
199 |
$16K |
| D0274 |
Bitewings - four radiographic images |
743 |
702 |
$14K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
252 |
69 |
$11K |
| 90791 |
Psychiatric diagnostic evaluation |
94 |
58 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,091 |
948 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
163 |
71 |
$6K |
| 11056 |
|
194 |
147 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
334 |
316 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
315 |
274 |
$4K |
| D9110 |
|
147 |
114 |
$3K |
| 99442 |
|
36 |
29 |
$3K |
| 96127 |
|
1,129 |
1,080 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
489 |
471 |
$3K |
| 82948 |
|
906 |
882 |
$2K |
| 90686 |
|
142 |
141 |
$2K |
| 99000 |
|
1,803 |
1,743 |
$2K |
| 99443 |
|
15 |
14 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
22 |
12 |
$1K |
| 99385 |
|
122 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
13 |
$1K |
| 90688 |
|
93 |
93 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
15 |
$811.73 |
| 3074F |
|
3,070 |
2,869 |
$772.50 |
| 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 |
24 |
12 |
$768.00 |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$764.08 |
| 3078F |
|
2,899 |
2,741 |
$682.50 |
| D2140 |
|
13 |
12 |
$430.76 |
| 3079F |
|
1,567 |
1,494 |
$400.00 |
| 11057 |
|
13 |
13 |
$358.09 |
| 90656 |
|
24 |
24 |
$189.12 |
| 1160F |
|
4,405 |
4,013 |
$90.00 |
| 1159F |
|
4,040 |
3,699 |
$80.00 |
| 3075F |
|
628 |
613 |
$75.00 |
| 1126F |
|
4,014 |
3,715 |
$70.00 |
| 3077F |
|
200 |
193 |
$55.00 |
| 1125F |
|
559 |
544 |
$10.00 |
| 3725F |
|
4,322 |
4,020 |
$0.00 |
| 3008F |
|
5,148 |
4,756 |
$0.00 |
| 1036F |
|
4,134 |
3,772 |
$0.00 |
| 1170F |
|
2,160 |
2,099 |
$0.00 |
| 1034F |
|
220 |
204 |
$0.00 |
| 3080F |
|
14 |
14 |
$0.00 |