| 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 |
23,838 |
20,849 |
$1.78M |
| 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 |
10,722 |
7,719 |
$783K |
| 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 |
7,676 |
7,625 |
$628K |
| D1110 |
Prophylaxis - adult |
2,217 |
2,205 |
$210K |
| D1351 |
Sealant - per tooth |
6,002 |
1,156 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,117 |
2,112 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,036 |
814 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
1,616 |
1,572 |
$128K |
| D1120 |
Prophylaxis - child |
2,546 |
2,544 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
895 |
687 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,260 |
3,248 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,130 |
2,121 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
615 |
323 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,977 |
1,973 |
$56K |
| 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 |
583 |
572 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
804 |
802 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,070 |
13,605 |
$30K |
| 59426 |
|
16 |
15 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,225 |
2,067 |
$23K |
| D1354 |
|
973 |
297 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,286 |
5,951 |
$18K |
| D0272 |
Bitewings - two radiographic images |
581 |
579 |
$13K |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,430 |
5,156 |
$11K |
| 90837 |
Psychotherapy, 53 minutes with patient |
639 |
396 |
$7K |
| D0191 |
|
490 |
489 |
$7K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
12 |
12 |
$7K |
| 90651 |
|
470 |
469 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,301 |
1,300 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,354 |
1,354 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
988 |
987 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
140 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,464 |
6,420 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,109 |
3,097 |
$3K |
| D4346 |
|
40 |
40 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,142 |
1,133 |
$3K |
| 0064A |
|
99 |
98 |
$3K |
| H0031 |
Mental health assessment, by non-physician |
508 |
504 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| 90480 |
|
64 |
64 |
$2K |
| 0001A |
|
58 |
57 |
$2K |
| 80305 |
|
4,508 |
3,594 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
824 |
632 |
$2K |
| 0134A |
|
59 |
59 |
$2K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
881 |
811 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,364 |
1,289 |
$1K |
| 0002A |
|
34 |
34 |
$1K |
| 0011A |
|
44 |
44 |
$1K |
| 90686 |
|
2,595 |
2,589 |
$1K |
| 0012A |
|
28 |
28 |
$966.35 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
249 |
249 |
$966.09 |
| 0004A |
|
26 |
26 |
$793.12 |
| 0124A |
|
28 |
28 |
$769.06 |
| 90715 |
|
448 |
446 |
$664.67 |
| 81025 |
|
1,979 |
1,790 |
$601.68 |
| 0071A |
|
15 |
15 |
$567.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
81 |
$559.60 |
| 90656 |
|
189 |
189 |
$558.75 |
| 90620 |
|
183 |
182 |
$519.60 |
| 91322 |
|
53 |
53 |
$435.00 |
| 0031A |
|
12 |
12 |
$416.35 |
| 0054A |
|
12 |
12 |
$375.30 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
107 |
104 |
$367.67 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
906 |
902 |
$305.52 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
98 |
98 |
$269.67 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
309 |
303 |
$173.98 |
| 92551 |
|
520 |
519 |
$163.71 |
| 81002 |
|
1,213 |
1,186 |
$138.66 |
| 90670 |
|
876 |
872 |
$129.00 |
| 85018 |
|
800 |
787 |
$122.68 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
124 |
64 |
$54.84 |
| 90474 |
|
176 |
176 |
$48.75 |
| 93000 |
|
52 |
49 |
$27.54 |
| 82947 |
|
88 |
86 |
$25.99 |
| 99406 |
|
413 |
398 |
$8.54 |
| 90619 |
|
125 |
125 |
$0.00 |
| 94760 |
|
3,657 |
3,447 |
$0.00 |
| 36416 |
|
130 |
127 |
$0.00 |
| 91301 |
|
55 |
55 |
$0.00 |
| D1330 |
|
937 |
936 |
$0.00 |
| 90723 |
|
482 |
479 |
$0.00 |
| 90647 |
|
374 |
371 |
$0.00 |
| 90677 |
|
89 |
89 |
$0.00 |
| 3044F |
|
164 |
162 |
$0.00 |
| 90680 |
|
106 |
106 |
$0.00 |
| 90732 |
|
12 |
12 |
$0.00 |
| 99383 |
|
26 |
26 |
$0.00 |
| 90632 |
|
18 |
18 |
$0.00 |
| 99381 |
|
29 |
29 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
40 |
33 |
$0.00 |
| 99384 |
|
17 |
17 |
$0.00 |
| D9990 |
|
36 |
35 |
$0.00 |
| 90734 |
|
131 |
131 |
$0.00 |
| 90633 |
|
164 |
162 |
$0.00 |
| 90685 |
|
76 |
76 |
$0.00 |
| 90746 |
|
45 |
44 |
$0.00 |
| 90681 |
|
58 |
58 |
$0.00 |
| 90648 |
|
68 |
68 |
$0.00 |