| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2315 |
Injection, naltrexone, depot form, 1 mg |
149 |
143 |
$175K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,685 |
1,563 |
$106K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
807 |
751 |
$33K |
| 90832 |
Psychotherapy, 30 minutes with patient |
261 |
219 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
305 |
302 |
$9K |
| D1110 |
Prophylaxis - adult |
141 |
131 |
$5K |
| D0330 |
Panoramic radiographic image |
296 |
250 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
286 |
$3K |
| D1206 |
Topical application of fluoride varnish |
85 |
85 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
46 |
$2K |
| D0274 |
Bitewings - four radiographic images |
66 |
66 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
153 |
147 |
$2K |
| D1120 |
Prophylaxis - child |
44 |
44 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
231 |
223 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
104 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$858.15 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
12 |
$506.61 |
| 99406 |
|
65 |
63 |
$499.79 |
| 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 |
33 |
33 |
$309.33 |
| 87430 |
|
33 |
32 |
$78.00 |
| 92551 |
|
14 |
13 |
$72.96 |
| 99173 |
|
15 |
14 |
$31.20 |
| 4004F |
|
119 |
107 |
$0.00 |
| 3078F |
|
286 |
266 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
395 |
299 |
$0.00 |
| 3077F |
|
22 |
19 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
49 |
46 |
$0.00 |
| 99408 |
|
18 |
18 |
$0.00 |
| 1036F |
|
327 |
305 |
$0.00 |
| 3008F |
|
880 |
803 |
$0.00 |
| 3074F |
|
389 |
359 |
$0.00 |
| 3079F |
|
111 |
107 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
89 |
82 |
$0.00 |
| 90656 |
|
19 |
17 |
$0.00 |
| 3080F |
|
14 |
14 |
$0.00 |