| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
139,715 |
123,716 |
$18.64M |
| D9450 |
|
33,662 |
21,079 |
$1.51M |
| 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 |
3,383 |
2,691 |
$714K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
16,823 |
14,023 |
$419K |
| D1110 |
Prophylaxis - adult |
8,296 |
5,503 |
$264K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,663 |
1,093 |
$230K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,387 |
1,385 |
$217K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,346 |
1,344 |
$198K |
| 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 |
6,695 |
5,647 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,655 |
2,035 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
4,010 |
2,769 |
$176K |
| D0140 |
Limited oral evaluation - problem focused |
6,266 |
4,120 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
9,654 |
6,765 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,313 |
1,627 |
$128K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12,253 |
12,061 |
$124K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,348 |
2,312 |
$114K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
813 |
808 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,559 |
2,710 |
$109K |
| D1120 |
Prophylaxis - child |
2,296 |
2,115 |
$107K |
| D2740 |
Crown - porcelain/ceramic |
172 |
124 |
$102K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
607 |
607 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,018 |
2,845 |
$97K |
| 90461 |
|
3,100 |
3,034 |
$81K |
| 97803 |
|
1,187 |
1,035 |
$71K |
| 96127 |
|
7,793 |
7,419 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,450 |
2,236 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,752 |
3,706 |
$52K |
| 99381 |
|
234 |
234 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,324 |
447 |
$48K |
| G0512 |
Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month |
378 |
377 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
668 |
432 |
$42K |
| D2330 |
|
735 |
353 |
$36K |
| D2331 |
|
585 |
337 |
$34K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,989 |
1,971 |
$28K |
| D0330 |
Panoramic radiographic image |
537 |
451 |
$28K |
| 91320 |
|
267 |
266 |
$27K |
| D2332 |
|
262 |
177 |
$26K |
| 90756 |
|
957 |
951 |
$20K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,278 |
1,032 |
$17K |
| 97802 |
|
135 |
135 |
$17K |
| D5110 |
|
27 |
25 |
$17K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
233 |
233 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
68 |
$12K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
596 |
541 |
$12K |
| D0272 |
Bitewings - two radiographic images |
336 |
308 |
$10K |
| D9110 |
|
292 |
236 |
$9K |
| 90480 |
|
256 |
255 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,077 |
486 |
$7K |
| D7250 |
|
51 |
15 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
659 |
646 |
$7K |
| 90686 |
|
615 |
613 |
$7K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
67 |
66 |
$6K |
| 99177 |
|
906 |
903 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,891 |
3,571 |
$4K |
| 90674 |
|
175 |
172 |
$4K |
| 0012A |
|
81 |
81 |
$4K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
41 |
41 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
47 |
33 |
$3K |
| 99050 |
|
58 |
54 |
$3K |
| D0180 |
|
109 |
79 |
$2K |
| 0011A |
|
146 |
146 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
14 |
$2K |
| 0124A |
|
102 |
102 |
$2K |
| 87634 |
|
33 |
31 |
$2K |
| 99188 |
|
75 |
75 |
$2K |
| D2335 |
|
15 |
12 |
$2K |
| 0054A |
|
46 |
46 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,423 |
1,325 |
$2K |
| 92551 |
|
187 |
186 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
65 |
$2K |
| 90656 |
|
92 |
92 |
$1K |
| 0001A |
|
47 |
39 |
$1K |
| 90694 |
|
57 |
57 |
$1K |
| 0071A |
|
32 |
32 |
$1K |
| 83655 |
|
91 |
89 |
$939.84 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
92 |
89 |
$905.78 |
| 90661 |
|
66 |
66 |
$810.70 |
| 0002A |
|
16 |
16 |
$733.93 |
| 0013A |
|
16 |
16 |
$728.05 |
| 0134A |
|
51 |
51 |
$705.95 |
| 92587 |
|
40 |
40 |
$686.10 |
| 85018 |
|
291 |
290 |
$681.22 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
76 |
75 |
$568.46 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
49 |
49 |
$567.60 |
| 0082A |
|
12 |
12 |
$550.44 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
69 |
65 |
$518.84 |
| 0031A |
|
14 |
14 |
$504.57 |
| 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 |
13 |
13 |
$487.63 |
| 99051 |
|
61 |
61 |
$463.68 |
| 0064A |
|
27 |
27 |
$391.02 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
314 |
274 |
$362.57 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
18 |
12 |
$355.59 |
| 99406 |
|
80 |
79 |
$335.21 |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
47 |
$279.00 |
| 87807 |
|
13 |
13 |
$118.10 |
| 94760 |
|
119 |
117 |
$65.31 |
| 96161 |
|
30 |
29 |
$62.06 |
| 81003 |
|
43 |
43 |
$57.12 |
| 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 |
132 |
131 |
$11.53 |
| 98966 |
|
14 |
14 |
$9.80 |
| J7611 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg |
14 |
14 |
$1.60 |
| 36416 |
|
863 |
709 |
$0.00 |
| 99000 |
|
1,878 |
1,855 |
$0.00 |
| 91301 |
|
429 |
429 |
$0.00 |
| D1330 |
|
839 |
710 |
$0.00 |
| 91307 |
|
181 |
179 |
$0.00 |
| 91303 |
|
56 |
56 |
$0.00 |
| D1310 |
|
73 |
58 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
117 |
116 |
$0.00 |
| 91305 |
|
57 |
57 |
$0.00 |
| 90697 |
|
13 |
13 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 90680 |
|
13 |
13 |
$0.00 |
| 91306 |
|
19 |
19 |
$0.00 |
| 99072 |
|
18,067 |
16,911 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
41 |
41 |
$0.00 |
| 91300 |
|
308 |
305 |
$0.00 |
| 99173 |
|
33 |
33 |
$0.00 |
| 91312 |
|
320 |
320 |
$0.00 |
| 91313 |
|
71 |
71 |
$0.00 |
| 91308 |
|
60 |
58 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 94150 |
|
43 |
43 |
$0.00 |
| 90670 |
|
26 |
26 |
$0.00 |
| 90658 |
|
15 |
15 |
$0.00 |
| 11135 |
|
28 |
14 |
$0.00 |