| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,256 |
2,658 |
$516K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
762 |
728 |
$148K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
790 |
751 |
$119K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
446 |
438 |
$92K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
33 |
30 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
42 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$636.00 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$434.60 |
| 90686 |
|
52 |
50 |
$230.13 |
| 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 |
77 |
57 |
$162.00 |
| 90723 |
|
184 |
181 |
$0.00 |
| 90688 |
|
114 |
109 |
$0.00 |
| 90647 |
|
101 |
96 |
$0.00 |
| 90670 |
|
422 |
406 |
$0.00 |
| 90671 |
|
44 |
44 |
$0.00 |
| G9920 |
Screening performed and negative |
116 |
101 |
$0.00 |
| 90633 |
|
38 |
37 |
$0.00 |
| 90681 |
|
26 |
25 |
$0.00 |
| G9919 |
Screening performed and positive and provision of recommendations |
17 |
14 |
$0.00 |
| 81003 |
|
12 |
12 |
$0.00 |