| 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 |
114,154 |
102,083 |
$7.85M |
| 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 |
36,333 |
36,037 |
$2.58M |
| D7140 |
Extraction, erupted tooth or exposed root |
13,898 |
8,039 |
$1.49M |
| D0140 |
Limited oral evaluation - problem focused |
14,706 |
14,013 |
$1.33M |
| 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 |
15,507 |
11,505 |
$1.11M |
| D1110 |
Prophylaxis - adult |
6,094 |
6,068 |
$616K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,669 |
3,031 |
$520K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,739 |
2,848 |
$415K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,675 |
4,646 |
$405K |
| D1120 |
Prophylaxis - child |
9,763 |
9,759 |
$396K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
442 |
421 |
$349K |
| 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 |
3,764 |
3,740 |
$328K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
77,508 |
71,165 |
$296K |
| D1206 |
Topical application of fluoride varnish |
11,427 |
11,410 |
$279K |
| D0120 |
Periodic oral evaluation - established patient |
6,323 |
6,307 |
$231K |
| D1351 |
Sealant - per tooth |
8,325 |
1,988 |
$209K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
4,058 |
4,046 |
$202K |
| D0274 |
Bitewings - four radiographic images |
6,325 |
6,307 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
835 |
765 |
$141K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
27,954 |
26,467 |
$130K |
| D4355 |
|
769 |
766 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
12,783 |
12,015 |
$104K |
| D0191 |
|
6,388 |
6,385 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
2,593 |
2,529 |
$82K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
369 |
209 |
$76K |
| 90651 |
|
3,487 |
3,481 |
$67K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,480 |
8,472 |
$62K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
8,416 |
8,336 |
$51K |
| D2331 |
|
385 |
327 |
$48K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
6,193 |
6,185 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
238 |
220 |
$41K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,836 |
3,833 |
$38K |
| D0330 |
Panoramic radiographic image |
1,156 |
1,150 |
$38K |
| D1354 |
|
1,918 |
690 |
$37K |
| D2330 |
|
427 |
317 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,624 |
1,622 |
$34K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15,882 |
15,838 |
$34K |
| D0270 |
|
4,414 |
4,332 |
$29K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27,802 |
27,697 |
$27K |
| H0031 |
Mental health assessment, by non-physician |
3,166 |
3,147 |
$26K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
3,254 |
3,243 |
$26K |
| D2335 |
|
131 |
115 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
139 |
$22K |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,575 |
4,625 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,840 |
2,571 |
$17K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,710 |
6,463 |
$15K |
| 0012A |
|
382 |
380 |
$14K |
| 0011A |
|
420 |
418 |
$14K |
| 99381 |
|
2,115 |
2,109 |
$14K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
2,381 |
2,374 |
$13K |
| 0001A |
|
304 |
303 |
$11K |
| 90620 |
|
2,151 |
2,145 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
469 |
469 |
$11K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,997 |
2,403 |
$10K |
| D2140 |
|
85 |
74 |
$9K |
| 0002A |
|
246 |
246 |
$9K |
| D2332 |
|
58 |
51 |
$8K |
| 0064A |
|
214 |
214 |
$7K |
| 81025 |
|
6,880 |
6,511 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,567 |
1,557 |
$7K |
| 99495 |
|
593 |
584 |
$6K |
| 90686 |
|
8,730 |
8,715 |
$6K |
| 0071A |
|
162 |
162 |
$6K |
| 90715 |
|
3,785 |
3,775 |
$5K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
1,164 |
924 |
$5K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
874 |
858 |
$5K |
| D0190 |
|
373 |
373 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
489 |
488 |
$4K |
| 90837 |
Psychotherapy, 53 minutes with patient |
895 |
683 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,862 |
2,814 |
$4K |
| 0134A |
|
113 |
112 |
$3K |
| 90656 |
|
809 |
808 |
$3K |
| D4346 |
|
42 |
42 |
$3K |
| 0072A |
|
84 |
84 |
$3K |
| 90480 |
|
92 |
92 |
$3K |
| 90474 |
|
4,603 |
4,599 |
$3K |
| 80305 |
|
3,397 |
2,648 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
12 |
$2K |
| 90677 |
|
1,178 |
1,176 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,222 |
616 |
$2K |
| 0003A |
|
47 |
47 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,523 |
3,503 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
538 |
536 |
$2K |
| 0124A |
|
62 |
60 |
$2K |
| 92551 |
|
2,118 |
2,117 |
$1K |
| 81002 |
|
5,039 |
4,936 |
$1K |
| 0031A |
|
31 |
31 |
$1K |
| 99385 |
|
94 |
94 |
$872.97 |
| 99384 |
|
76 |
76 |
$794.96 |
| 99383 |
|
209 |
209 |
$769.84 |
| D0145 |
Oral evaluation for a patient under three years of age |
23 |
23 |
$616.00 |
| 90734 |
|
1,710 |
1,705 |
$600.00 |
| 99382 |
|
50 |
50 |
$521.92 |
| 90619 |
|
1,054 |
1,052 |
$509.24 |
| 0081A |
|
14 |
13 |
$454.72 |
| 0052A |
|
13 |
13 |
$450.36 |
| 82947 |
|
1,297 |
1,236 |
$330.79 |
| 90632 |
|
91 |
90 |
$302.54 |
| 90746 |
|
91 |
90 |
$248.00 |
| 93000 |
|
242 |
242 |
$228.13 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
247 |
242 |
$192.15 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
197 |
187 |
$184.44 |
| 91322 |
|
58 |
58 |
$145.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
153 |
151 |
$144.66 |
| 90670 |
|
6,882 |
6,868 |
$129.00 |
| 96381 |
|
34 |
34 |
$115.15 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
349 |
322 |
$106.87 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
19 |
18 |
$95.97 |
| 90716 |
|
4,209 |
4,203 |
$91.00 |
| G0008 |
Administration of influenza virus vaccine |
239 |
225 |
$85.52 |
| 90707 |
|
4,192 |
4,187 |
$77.15 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
62 |
61 |
$70.41 |
| 90674 |
|
12 |
12 |
$48.10 |
| 96160 |
|
36 |
36 |
$34.88 |
| 99406 |
|
799 |
792 |
$33.82 |
| 90685 |
|
491 |
485 |
$21.81 |
| 86580 |
|
16 |
16 |
$17.82 |
| 85610 |
|
15 |
12 |
$17.75 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
39 |
39 |
$9.85 |
| 90696 |
|
1,898 |
1,896 |
$0.00 |
| 3044F |
|
1,286 |
1,276 |
$0.00 |
| 90680 |
|
4,176 |
4,174 |
$0.00 |
| 94760 |
|
8,258 |
7,895 |
$0.00 |
| 90723 |
|
6,647 |
6,636 |
$0.00 |
| D1330 |
|
2,493 |
2,481 |
$0.00 |
| 90647 |
|
4,102 |
4,096 |
$0.00 |
| 90381 |
|
29 |
29 |
$0.00 |
| 91301 |
|
453 |
451 |
$0.00 |
| 36416 |
|
392 |
371 |
$0.00 |
| 3052F |
|
65 |
65 |
$0.00 |
| 91303 |
|
30 |
30 |
$0.00 |
| 90688 |
|
15 |
15 |
$0.00 |
| 90633 |
|
4,404 |
4,401 |
$0.00 |
| 3046F |
|
705 |
703 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
307 |
292 |
$0.00 |
| 3051F |
|
326 |
326 |
$0.00 |
| 90648 |
|
2,211 |
2,211 |
$0.00 |
| 90681 |
|
440 |
438 |
$0.00 |
| 90700 |
|
1,801 |
1,797 |
$0.00 |
| D0412 |
|
375 |
335 |
$0.00 |
| 90662 |
|
109 |
106 |
$0.00 |
| 91321 |
|
16 |
16 |
$0.00 |
| 91300 |
|
47 |
47 |
$0.00 |