| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,445 |
15,864 |
$2.00M |
| 00003 |
Internal/system code - not a standard HCPCS code |
2,778 |
2,514 |
$436K |
| G9012 |
Other specified case management service not elsewhere classified |
852 |
472 |
$40K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,454 |
3,994 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,186 |
1,132 |
$2K |
| D1310 |
|
1,395 |
867 |
$1K |
| D4341 |
|
191 |
110 |
$870.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
92 |
$573.00 |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
373 |
$569.00 |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
113 |
$513.00 |
| D0120 |
Periodic oral evaluation - established patient |
46 |
46 |
$315.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
130 |
$272.40 |
| 0002A |
|
18 |
16 |
$254.00 |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$199.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
413 |
411 |
$109.12 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
413 |
411 |
$108.86 |
| D0603 |
|
606 |
459 |
$108.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$43.20 |
| 0031A |
|
54 |
54 |
$40.00 |
| D4342 |
|
13 |
13 |
$40.00 |
| D9430 |
|
12 |
12 |
$22.00 |
| 81025 |
|
27 |
26 |
$11.20 |
| 81001 |
|
298 |
297 |
$7.26 |
| 82947 |
|
471 |
470 |
$3.11 |
| 85018 |
|
446 |
444 |
$2.37 |
| 91300 |
|
118 |
116 |
$0.00 |
| 3077F |
|
281 |
277 |
$0.00 |
| 99173 |
|
113 |
112 |
$0.00 |
| 1160F |
|
15 |
15 |
$0.00 |
| D9993 |
|
577 |
543 |
$0.00 |
| 3078F |
|
2,710 |
2,610 |
$0.00 |
| 99442 |
|
500 |
411 |
$0.00 |
| G9920 |
Screening performed and negative |
118 |
113 |
$0.00 |
| 80061 |
Lipid panel |
382 |
381 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
49 |
49 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$0.00 |
| 85049 |
|
30 |
30 |
$0.00 |
| 90715 |
|
26 |
26 |
$0.00 |
| 92552 |
|
60 |
59 |
$0.00 |
| 3075F |
|
91 |
90 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
868 |
864 |
$0.00 |
| 90674 |
|
121 |
121 |
$0.00 |
| 91303 |
|
53 |
52 |
$0.00 |
| D1330 |
|
1,410 |
960 |
$0.00 |
| 99000 |
|
814 |
767 |
$0.00 |
| H0002 |
Behavioral health screening to determine eligibility for admission to treatment program |
1,167 |
1,039 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
364 |
359 |
$0.00 |
| 90686 |
|
123 |
123 |
$0.00 |
| 3074F |
|
2,263 |
2,182 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
306 |
306 |
$0.00 |
| 3079F |
|
116 |
116 |
$0.00 |
| 90688 |
|
17 |
17 |
$0.00 |
| 87529 |
|
14 |
14 |
$0.00 |
| 90739 |
|
27 |
27 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
95 |
94 |
$0.00 |
| 82270 |
|
33 |
33 |
$0.00 |
| 1111F |
|
13 |
13 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$0.00 |
| 3008F |
|
27 |
27 |
$0.00 |