| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,729 |
10,322 |
$2.02M |
| D0999 |
Unspecified diagnostic procedure, by report |
3,747 |
3,291 |
$482K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
455 |
287 |
$30K |
| 99000 |
|
347 |
307 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
367 |
290 |
$85.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
34 |
29 |
$84.62 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,653 |
6,610 |
$47.56 |
| 96127 |
|
2,226 |
1,585 |
$29.20 |
| 90686 |
|
177 |
167 |
$22.35 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
348 |
344 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
759 |
729 |
$0.00 |
| 3075F |
|
390 |
363 |
$0.00 |
| 3008F |
|
3,189 |
2,808 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
76 |
54 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,026 |
1,002 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
196 |
173 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
309 |
277 |
$0.00 |
| 3079F |
|
709 |
650 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,135 |
1,094 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
239 |
229 |
$0.00 |
| 3074F |
|
2,093 |
1,931 |
$0.00 |
| D1351 |
Sealant - per tooth |
73 |
54 |
$0.00 |
| 1036F |
|
3,351 |
2,774 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
92 |
92 |
$0.00 |
| 99383 |
|
22 |
13 |
$0.00 |
| 3080F |
|
16 |
16 |
$0.00 |
| 99384 |
|
14 |
12 |
$0.00 |
| 90656 |
|
15 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
791 |
778 |
$0.00 |
| 3725F |
|
2,823 |
2,519 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,473 |
880 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
625 |
566 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
145 |
113 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
355 |
302 |
$0.00 |
| 1160F |
|
3,057 |
2,515 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
544 |
531 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
156 |
$0.00 |
| 90461 |
|
134 |
82 |
$0.00 |
| 3078F |
|
2,116 |
1,948 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,053 |
1,003 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
14 |
13 |
$0.00 |
| 3077F |
|
410 |
358 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
17 |
14 |
$0.00 |
| D1110 |
Prophylaxis - adult |
70 |
62 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
12 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$0.00 |
| D0270 |
|
25 |
25 |
$0.00 |