| 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 |
26,037 |
23,022 |
$1.93M |
| 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 |
8,895 |
8,739 |
$718K |
| 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 |
9,619 |
7,623 |
$710K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,302 |
3,475 |
$627K |
| D0140 |
Limited oral evaluation - problem focused |
5,897 |
5,740 |
$454K |
| D1110 |
Prophylaxis - adult |
4,799 |
4,791 |
$423K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,848 |
2,352 |
$410K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,112 |
3,101 |
$265K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,353 |
1,735 |
$237K |
| D1120 |
Prophylaxis - child |
4,465 |
4,465 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
4,061 |
4,054 |
$153K |
| D1206 |
Topical application of fluoride varnish |
5,217 |
5,217 |
$131K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
193 |
185 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
566 |
510 |
$96K |
| 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 |
1,006 |
983 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
2,331 |
2,320 |
$70K |
| D0191 |
|
3,527 |
3,526 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,558 |
2,552 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
5,626 |
5,441 |
$39K |
| D2331 |
|
325 |
247 |
$37K |
| D4355 |
|
241 |
240 |
$32K |
| D2330 |
|
404 |
283 |
$30K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,351 |
12,968 |
$27K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,845 |
4,071 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
91 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,586 |
9,062 |
$19K |
| D1351 |
Sealant - per tooth |
578 |
144 |
$17K |
| 90651 |
|
864 |
856 |
$13K |
| D0272 |
Bitewings - two radiographic images |
592 |
592 |
$12K |
| H0031 |
Mental health assessment, by non-physician |
2,354 |
2,292 |
$10K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,173 |
919 |
$9K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,660 |
1,640 |
$7K |
| 0001A |
|
195 |
195 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,550 |
1,535 |
$6K |
| 0002A |
|
172 |
172 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,544 |
1,530 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,075 |
4,030 |
$6K |
| 90837 |
Psychotherapy, 53 minutes with patient |
670 |
492 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,147 |
8,026 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,281 |
1,270 |
$5K |
| D2332 |
|
36 |
25 |
$5K |
| 90480 |
|
137 |
137 |
$4K |
| D0270 |
|
737 |
725 |
$3K |
| 0071A |
|
84 |
84 |
$3K |
| 0134A |
|
114 |
114 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
891 |
633 |
$3K |
| 0012A |
|
72 |
72 |
$3K |
| 0072A |
|
72 |
71 |
$3K |
| 0011A |
|
85 |
84 |
$3K |
| 0003A |
|
80 |
80 |
$2K |
| D2394 |
|
15 |
13 |
$2K |
| D4346 |
|
24 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
82 |
$2K |
| 0004A |
|
48 |
48 |
$2K |
| 90686 |
|
3,608 |
3,577 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
246 |
244 |
$1K |
| 90677 |
|
319 |
319 |
$1K |
| 0124A |
|
96 |
95 |
$916.87 |
| 90715 |
|
728 |
716 |
$861.89 |
| 0031A |
|
22 |
22 |
$832.70 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,936 |
1,902 |
$731.34 |
| 90656 |
|
174 |
174 |
$692.85 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
593 |
530 |
$642.03 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
64 |
62 |
$434.14 |
| 98968 |
|
19 |
13 |
$402.48 |
| 0013A |
|
16 |
16 |
$378.18 |
| 90620 |
|
116 |
116 |
$344.60 |
| 0054A |
|
13 |
13 |
$339.14 |
| 85018 |
|
2,102 |
2,079 |
$332.23 |
| 81025 |
|
881 |
820 |
$329.87 |
| 91322 |
|
99 |
99 |
$319.00 |
| 80305 |
|
954 |
756 |
$312.59 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
64 |
64 |
$283.72 |
| 90716 |
|
311 |
307 |
$272.52 |
| 90474 |
|
558 |
554 |
$240.01 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
182 |
173 |
$211.18 |
| 90632 |
|
44 |
44 |
$173.97 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
72 |
56 |
$148.12 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
155 |
75 |
$137.10 |
| 90670 |
|
1,308 |
1,296 |
$129.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
12 |
$96.47 |
| 90707 |
|
349 |
345 |
$77.15 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
69 |
59 |
$67.88 |
| 90746 |
|
30 |
30 |
$62.00 |
| 81002 |
|
308 |
295 |
$53.72 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
13 |
12 |
$19.70 |
| 92551 |
|
47 |
47 |
$8.09 |
| 99406 |
|
244 |
218 |
$0.09 |
| 90647 |
|
755 |
748 |
$0.00 |
| 94760 |
|
3,568 |
3,383 |
$0.00 |
| 90680 |
|
642 |
637 |
$0.00 |
| 90723 |
|
1,095 |
1,088 |
$0.00 |
| D1330 |
|
858 |
846 |
$0.00 |
| 91301 |
|
107 |
107 |
$0.00 |
| 90688 |
|
138 |
137 |
$0.00 |
| 90619 |
|
72 |
72 |
$0.00 |
| 90696 |
|
51 |
51 |
$0.00 |
| 3044F |
|
170 |
170 |
$0.00 |
| 36416 |
|
44 |
44 |
$0.00 |
| 99495 |
|
12 |
12 |
$0.00 |
| 99381 |
|
12 |
12 |
$0.00 |
| 91303 |
|
22 |
22 |
$0.00 |
| 90633 |
|
511 |
502 |
$0.00 |
| 90685 |
|
197 |
186 |
$0.00 |
| 90734 |
|
355 |
353 |
$0.00 |
| 3046F |
|
79 |
79 |
$0.00 |
| 90710 |
|
26 |
26 |
$0.00 |
| 3045F |
|
29 |
29 |
$0.00 |
| 90648 |
|
303 |
303 |
$0.00 |
| 91300 |
|
23 |
23 |
$0.00 |
| 90662 |
|
13 |
13 |
$0.00 |
| 90700 |
|
13 |
13 |
$0.00 |
| 3051F |
|
12 |
12 |
$0.00 |
| D0412 |
|
28 |
26 |
$0.00 |
| D9991 |
|
15 |
13 |
$0.00 |