| 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 |
5,756 |
5,209 |
$413K |
| 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 |
799 |
339 |
$59K |
| D1110 |
Prophylaxis - adult |
793 |
786 |
$59K |
| D1120 |
Prophylaxis - child |
1,454 |
1,452 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,086 |
2,079 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,069 |
2,065 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
367 |
$24K |
| D1351 |
Sealant - per tooth |
766 |
348 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
205 |
179 |
$18K |
| D2140 |
|
220 |
204 |
$17K |
| D0272 |
Bitewings - two radiographic images |
753 |
753 |
$16K |
| D0274 |
Bitewings - four radiographic images |
507 |
504 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,210 |
1,996 |
$6K |
| 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 |
66 |
66 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
37 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,627 |
1,478 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
437 |
431 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
42 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
283 |
282 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
310 |
308 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
143 |
65 |
$556.95 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
81 |
81 |
$551.48 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
550 |
543 |
$502.46 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
187 |
182 |
$280.91 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
366 |
359 |
$233.72 |
| D0191 |
|
15 |
15 |
$182.00 |
| 99000 |
|
25 |
25 |
$135.69 |
| 90686 |
|
144 |
142 |
$96.12 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
110 |
110 |
$94.91 |
| 94010 |
|
66 |
63 |
$80.44 |
| 81003 |
|
571 |
546 |
$63.04 |
| 87428 |
|
29 |
29 |
$51.24 |
| D0190 |
|
96 |
96 |
$30.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
136 |
81 |
$27.42 |
| 83655 |
|
28 |
28 |
$12.38 |
| 85018 |
|
27 |
27 |
$7.29 |
| 86580 |
|
13 |
13 |
$4.56 |
| 3725F |
|
768 |
731 |
$0.00 |
| 3078F |
|
857 |
804 |
$0.00 |
| 99173 |
|
49 |
49 |
$0.00 |
| 90734 |
|
40 |
40 |
$0.00 |
| 90715 |
|
12 |
12 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |
| 3075F |
|
38 |
38 |
$0.00 |
| 3074F |
|
996 |
935 |
$0.00 |
| 3079F |
|
201 |
191 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
123 |
55 |
$0.00 |
| 3008F |
|
32 |
32 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| D0603 |
|
32 |
31 |
$0.00 |