| 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 |
24,477 |
21,566 |
$1.78M |
| 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 |
6,135 |
4,324 |
$467K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,613 |
2,263 |
$419K |
| D0140 |
Limited oral evaluation - problem focused |
3,840 |
3,714 |
$317K |
| 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 |
3,767 |
3,739 |
$313K |
| D1110 |
Prophylaxis - adult |
2,170 |
2,153 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,307 |
982 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,998 |
1,991 |
$137K |
| D1120 |
Prophylaxis - child |
3,023 |
3,019 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,108 |
3,097 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
895 |
670 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,722 |
3,714 |
$88K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,413 |
3,679 |
$73K |
| 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 |
684 |
666 |
$61K |
| D1351 |
Sealant - per tooth |
2,027 |
432 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,848 |
1,845 |
$50K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,128 |
13,639 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
831 |
823 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,745 |
3,634 |
$32K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,722 |
1,310 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,951 |
7,554 |
$24K |
| D0272 |
Bitewings - two radiographic images |
522 |
522 |
$11K |
| D0191 |
|
629 |
627 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
34 |
$6K |
| D4355 |
|
41 |
41 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
158 |
$4K |
| D1354 |
|
169 |
73 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,011 |
684 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
172 |
172 |
$4K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
213 |
89 |
$3K |
| D0270 |
|
433 |
429 |
$3K |
| 0011A |
|
101 |
101 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,705 |
3,665 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,637 |
1,623 |
$2K |
| D2330 |
|
26 |
15 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
279 |
276 |
$2K |
| 0012A |
|
60 |
60 |
$2K |
| 90837 |
Psychotherapy, 53 minutes with patient |
96 |
81 |
$1K |
| 80305 |
|
3,211 |
2,560 |
$1K |
| 0001A |
|
31 |
30 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
223 |
223 |
$1K |
| 90656 |
|
195 |
194 |
$983.40 |
| 90686 |
|
1,600 |
1,588 |
$939.63 |
| H0038 |
Self-help/peer services, per 15 minutes |
67 |
41 |
$837.50 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
132 |
132 |
$812.53 |
| 90480 |
|
28 |
28 |
$799.60 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
177 |
175 |
$789.96 |
| 90651 |
|
75 |
75 |
$787.23 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
544 |
513 |
$759.15 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
13 |
13 |
$747.00 |
| H0031 |
Mental health assessment, by non-physician |
199 |
193 |
$729.68 |
| 90620 |
|
40 |
40 |
$728.80 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
156 |
113 |
$536.88 |
| 0002A |
|
14 |
14 |
$529.90 |
| 90746 |
|
292 |
289 |
$496.00 |
| 0031A |
|
14 |
14 |
$492.05 |
| 81025 |
|
1,571 |
1,356 |
$426.05 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,238 |
1,229 |
$355.62 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
297 |
269 |
$330.03 |
| 0003A |
|
13 |
13 |
$302.80 |
| 90677 |
|
122 |
122 |
$298.04 |
| 90632 |
|
181 |
179 |
$234.56 |
| 90715 |
|
102 |
102 |
$198.34 |
| 91322 |
|
26 |
26 |
$145.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
80 |
76 |
$126.59 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
25 |
25 |
$96.47 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
246 |
124 |
$82.26 |
| 92551 |
|
107 |
107 |
$62.62 |
| H0001 |
Alcohol and/or drug assessment |
12 |
12 |
$61.48 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
17 |
16 |
$60.02 |
| 81002 |
|
375 |
358 |
$45.14 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
36 |
36 |
$13.12 |
| 85018 |
|
30 |
30 |
$4.93 |
| 99406 |
|
160 |
153 |
$0.07 |
| D9991 |
|
41 |
41 |
$0.00 |
| 3046F |
|
24 |
24 |
$0.00 |
| 90633 |
|
25 |
25 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
41 |
41 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 91300 |
|
16 |
16 |
$0.00 |
| D1330 |
|
912 |
908 |
$0.00 |
| 94760 |
|
1,015 |
965 |
$0.00 |
| 3044F |
|
86 |
85 |
$0.00 |
| 99495 |
|
25 |
25 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
62 |
61 |
$0.00 |
| 90647 |
|
53 |
53 |
$0.00 |
| 36416 |
|
35 |
35 |
$0.00 |
| 91301 |
|
119 |
119 |
$0.00 |
| 90619 |
|
26 |
26 |
$0.00 |
| 90474 |
|
16 |
16 |
$0.00 |
| 90723 |
|
42 |
42 |
$0.00 |
| 99381 |
|
16 |
15 |
$0.00 |
| 90680 |
|
16 |
16 |
$0.00 |