| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
153,027 |
134,411 |
$20.50M |
| 00003 |
Internal/system code - not a standard HCPCS code |
45,590 |
44,054 |
$7.69M |
| 90834 |
Psychotherapy, 45 minutes with patient |
4,407 |
2,822 |
$90K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
31,787 |
30,139 |
$55K |
| 90791 |
Psychiatric diagnostic evaluation |
1,069 |
720 |
$33K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,865 |
3,844 |
$31K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,422 |
4,396 |
$28K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,380 |
2,356 |
$24K |
| G9012 |
Other specified case management service not elsewhere classified |
236 |
163 |
$21K |
| D1310 |
|
8,887 |
4,332 |
$18K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,107 |
668 |
$14K |
| 92551 |
|
1,147 |
1,143 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
2,343 |
1,648 |
$10K |
| D1120 |
Prophylaxis - child |
997 |
694 |
$10K |
| 92552 |
|
10,406 |
10,318 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,666 |
2,631 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,474 |
1,052 |
$6K |
| 83655 |
|
2,231 |
2,216 |
$5K |
| J3490 |
Unclassified drugs |
157 |
137 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
396 |
393 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,258 |
1,228 |
$2K |
| 99173 |
|
10,490 |
10,406 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,998 |
2,076 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,827 |
1,979 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,899 |
5,748 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
183 |
91 |
$1K |
| 85018 |
|
5,565 |
5,528 |
$1K |
| 81025 |
|
1,541 |
1,521 |
$1K |
| D0603 |
|
3,301 |
2,051 |
$900.02 |
| 0001A |
|
144 |
141 |
$862.00 |
| 57454 |
|
23 |
12 |
$577.35 |
| D0602 |
|
548 |
372 |
$574.00 |
| D0274 |
Bitewings - four radiographic images |
495 |
373 |
$507.60 |
| D1206 |
Topical application of fluoride varnish |
146 |
101 |
$489.50 |
| D4341 |
|
35 |
28 |
$460.00 |
| D9993 |
|
3,541 |
3,280 |
$420.00 |
| D1351 |
Sealant - per tooth |
165 |
28 |
$243.00 |
| 92081 |
|
89 |
89 |
$228.34 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
848 |
841 |
$221.34 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
848 |
841 |
$221.08 |
| 90670 |
|
3,209 |
3,184 |
$195.13 |
| 90633 |
|
1,962 |
1,951 |
$176.89 |
| 90649 |
|
82 |
81 |
$163.07 |
| D0140 |
Limited oral evaluation - problem focused |
1,242 |
664 |
$138.60 |
| 90716 |
|
581 |
579 |
$124.47 |
| 90734 |
|
844 |
839 |
$119.90 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$97.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$95.90 |
| 86580 |
|
40 |
40 |
$76.59 |
| 99000 |
|
4,784 |
4,672 |
$71.13 |
| 90715 |
|
772 |
772 |
$43.50 |
| 90647 |
|
2,230 |
2,219 |
$31.69 |
| G9920 |
Screening performed and negative |
737 |
725 |
$0.16 |
| 90681 |
|
430 |
429 |
$0.00 |
| 82947 |
|
1,341 |
1,312 |
$0.00 |
| Z6400 |
|
1,266 |
1,260 |
$0.00 |
| Z6302 |
|
151 |
149 |
$0.00 |
| Z6414 |
|
555 |
400 |
$0.00 |
| 0502F |
|
6,861 |
5,056 |
$0.00 |
| D0350 |
|
875 |
453 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
24 |
24 |
$0.00 |
| 85049 |
|
621 |
619 |
$0.00 |
| Z6500 |
|
135 |
135 |
$0.00 |
| 99442 |
|
2,168 |
2,097 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
782 |
770 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
359 |
359 |
$0.00 |
| 3078F |
|
561 |
512 |
$0.00 |
| Z6308 |
|
26 |
26 |
$0.00 |
| Z6202 |
|
396 |
377 |
$0.00 |
| 90707 |
|
282 |
279 |
$0.00 |
| 91300 |
|
506 |
485 |
$0.00 |
| 90710 |
|
72 |
72 |
$0.00 |
| Z6200 |
|
379 |
379 |
$0.00 |
| 0002A |
|
117 |
114 |
$0.00 |
| 90700 |
|
35 |
33 |
$0.00 |
| D9430 |
|
217 |
94 |
$0.00 |
| 81002 |
|
27 |
27 |
$0.00 |
| Z6208 |
|
26 |
26 |
$0.00 |
| 90713 |
|
28 |
28 |
$0.00 |
| 1160F |
|
40 |
39 |
$0.00 |
| Z6300 |
|
29 |
29 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
14 |
$0.00 |
| 80061 |
Lipid panel |
15 |
15 |
$0.00 |
| 90723 |
|
2,299 |
2,287 |
$0.00 |
| Z6404 |
|
148 |
148 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,068 |
1,056 |
$0.00 |
| D1330 |
|
8,092 |
4,252 |
$0.00 |
| 3080F |
|
248 |
247 |
$0.00 |
| 90688 |
|
7,524 |
7,463 |
$0.00 |
| 1111F |
|
40 |
39 |
$0.00 |
| Z6410 |
|
2,033 |
1,474 |
$0.00 |
| Z1034 |
|
6,866 |
5,106 |
$0.00 |
| H0033 |
Oral medication administration, direct observation |
412 |
350 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,941 |
1,887 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
2,988 |
2,953 |
$0.00 |
| 0501F |
|
733 |
730 |
$0.00 |
| 81001 |
|
8,299 |
6,272 |
$0.00 |
| Z6402 |
|
27 |
27 |
$0.00 |
| 90651 |
|
1,087 |
1,082 |
$0.00 |
| Z1032 |
|
796 |
783 |
$0.00 |
| 3074F |
|
990 |
925 |
$0.00 |
| D9995 |
|
419 |
349 |
$0.00 |
| Z1038 |
|
142 |
132 |
$0.00 |
| 3008F |
|
4,214 |
4,161 |
$0.00 |
| 0500F |
|
34 |
34 |
$0.00 |
| 99441 |
|
829 |
805 |
$0.00 |
| 99384 |
|
14 |
14 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
66 |
66 |
$0.00 |
| 91307 |
|
168 |
165 |
$0.00 |
| 0503F |
|
142 |
132 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
302 |
173 |
$0.00 |
| 90696 |
|
66 |
66 |
$0.00 |
| 96127 |
|
17 |
17 |
$0.00 |
| 99381 |
|
55 |
55 |
$0.00 |
| 90744 |
|
15 |
15 |
$0.00 |
| 90620 |
|
41 |
41 |
$0.00 |
| 3079F |
|
26 |
26 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
59 |
58 |
$0.00 |
| 1MOFU |
|
37 |
36 |
$0.00 |
| 99383 |
|
24 |
24 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
23 |
13 |
$0.00 |
| D6000 |
|
19 |
19 |
$0.00 |
| 90674 |
|
32 |
32 |
$0.00 |