| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
62,725 |
37,284 |
$3.55M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43,267 |
24,837 |
$737K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,909 |
6,087 |
$287K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,675 |
4,791 |
$118K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,796 |
2,009 |
$69K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,762 |
1,189 |
$56K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,490 |
980 |
$41K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,365 |
913 |
$39K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,417 |
2,179 |
$37K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,299 |
1,556 |
$35K |
| 92015 |
Determination of refractive state |
2,792 |
2,045 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
811 |
552 |
$23K |
| D0330 |
Panoramic radiographic image |
1,638 |
1,078 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
2,914 |
1,848 |
$21K |
| 80305 |
|
3,929 |
2,069 |
$20K |
| 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 |
631 |
450 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,766 |
1,141 |
$16K |
| 81025 |
|
4,520 |
3,241 |
$15K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
1,874 |
924 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
668 |
255 |
$12K |
| D1110 |
Prophylaxis - adult |
929 |
619 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
968 |
717 |
$9K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
361 |
169 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
168 |
99 |
$9K |
| 81002 |
|
6,307 |
4,403 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
602 |
379 |
$8K |
| 90715 |
|
356 |
278 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
3,126 |
2,009 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
171 |
116 |
$5K |
| 90651 |
|
624 |
502 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,033 |
767 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
624 |
424 |
$3K |
| 90633 |
|
156 |
119 |
$3K |
| H1002 |
Prenatal care, at risk enhanced service; care coordination |
435 |
264 |
$2K |
| 87210 |
|
1,201 |
852 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
187 |
104 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
102 |
98 |
$2K |
| 90716 |
|
12 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
29 |
$2K |
| 92250 |
|
84 |
56 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
462 |
265 |
$2K |
| D1120 |
Prophylaxis - child |
154 |
88 |
$1K |
| 90834 |
Psychotherapy, 45 minutes with patient |
109 |
45 |
$1K |
| 86580 |
|
322 |
238 |
$996.15 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
19 |
12 |
$899.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
646 |
204 |
$865.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
45 |
27 |
$750.88 |
| D1208 |
Topical application of fluoride, excluding varnish |
104 |
59 |
$645.00 |
| 90670 |
|
146 |
117 |
$583.84 |
| 99383 |
|
19 |
12 |
$556.52 |
| 82948 |
|
341 |
182 |
$546.43 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$540.00 |
| 99385 |
|
17 |
12 |
$294.72 |
| V2020 |
Frames, purchases |
14 |
13 |
$240.00 |
| D0272 |
Bitewings - two radiographic images |
65 |
40 |
$230.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
606 |
441 |
$209.31 |
| 0011A |
|
12 |
12 |
$138.92 |
| 90688 |
|
962 |
763 |
$3.29 |
| 90734 |
|
345 |
269 |
$1.15 |
| 90686 |
|
67 |
51 |
$0.42 |
| 90685 |
|
191 |
166 |
$0.24 |
| 90696 |
|
32 |
29 |
$0.17 |
| 90620 |
|
33 |
25 |
$0.10 |
| 90744 |
|
20 |
18 |
$0.00 |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
15 |
15 |
$0.00 |
| 90698 |
|
43 |
27 |
$0.00 |
| 3074F |
|
24 |
17 |
$0.00 |
| 90723 |
|
22 |
20 |
$0.00 |
| 90461 |
|
1,329 |
1,083 |
$0.00 |
| 99307 |
|
57 |
39 |
$0.00 |
| 90648 |
|
24 |
22 |
$0.00 |
| 3078F |
|
36 |
14 |
$0.00 |
| 4004F |
|
27 |
21 |
$0.00 |