| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,591 |
7,701 |
$317K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,347 |
3,043 |
$192K |
| T2003 |
Non-emergency transportation; encounter/trip |
11,841 |
5,403 |
$134K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,093 |
1,591 |
$100K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,759 |
3,234 |
$79K |
| D1110 |
Prophylaxis - adult |
1,805 |
1,774 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,601 |
1,565 |
$39K |
| D0330 |
Panoramic radiographic image |
816 |
798 |
$35K |
| T1015 |
Clinic visit/encounter, all-inclusive |
5,834 |
3,623 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
567 |
344 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,370 |
1,287 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
494 |
485 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,288 |
1,266 |
$22K |
| 0011A |
|
541 |
470 |
$19K |
| D1120 |
Prophylaxis - child |
999 |
980 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
323 |
251 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,135 |
1,113 |
$15K |
| D0274 |
Bitewings - four radiographic images |
829 |
811 |
$14K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
14 |
14 |
$14K |
| 90832 |
Psychotherapy, 30 minutes with patient |
370 |
331 |
$14K |
| 0012A |
|
474 |
416 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
240 |
232 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
193 |
$12K |
| 99441 |
|
974 |
839 |
$9K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
754 |
648 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
492 |
368 |
$8K |
| D1351 |
Sealant - per tooth |
287 |
67 |
$7K |
| 90837 |
Psychotherapy, 53 minutes with patient |
103 |
81 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,397 |
411 |
$6K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
55 |
53 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,062 |
1,029 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
72 |
72 |
$4K |
| 81025 |
|
729 |
580 |
$4K |
| 90791 |
Psychiatric diagnostic evaluation |
45 |
41 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
253 |
222 |
$3K |
| 11721 |
|
180 |
164 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
179 |
177 |
$2K |
| 0064A |
|
88 |
69 |
$2K |
| 0001A |
|
75 |
62 |
$2K |
| 99215 |
Prolong outpt/office vis |
20 |
19 |
$2K |
| 92551 |
|
255 |
247 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
24 |
24 |
$1K |
| 99385 |
|
14 |
14 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$986.37 |
| 0004A |
|
52 |
36 |
$960.82 |
| 99201 |
|
54 |
52 |
$856.58 |
| 90674 |
|
45 |
44 |
$822.61 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$801.07 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$784.71 |
| 96160 |
|
286 |
277 |
$702.32 |
| 99173 |
|
286 |
276 |
$637.56 |
| D0272 |
Bitewings - two radiographic images |
67 |
65 |
$580.00 |
| 81003 |
|
480 |
365 |
$562.97 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
52 |
31 |
$521.69 |
| 90686 |
|
105 |
104 |
$469.10 |
| 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 |
34 |
27 |
$423.94 |
| 0002A |
|
22 |
15 |
$354.72 |
| 86703 |
|
27 |
27 |
$343.37 |
| 80305 |
|
73 |
55 |
$329.32 |
| 82962 |
|
171 |
157 |
$314.81 |
| D1320 |
|
20 |
20 |
$243.67 |
| 11056 |
|
13 |
12 |
$206.67 |
| 86580 |
|
31 |
31 |
$171.10 |
| 96127 |
|
30 |
30 |
$168.25 |
| 90461 |
|
108 |
57 |
$55.00 |
| 91301 |
|
1,183 |
1,016 |
$7.00 |
| 91300 |
|
332 |
259 |
$1.37 |
| 91307 |
|
78 |
72 |
$0.32 |
| 91306 |
|
89 |
69 |
$0.31 |
| 3074F |
|
6,939 |
6,020 |
$0.01 |
| 3075F |
|
1,279 |
1,150 |
$0.00 |
| 3079F |
|
4,101 |
3,646 |
$0.00 |
| D4355 |
|
14 |
14 |
$0.00 |
| D1310 |
|
89 |
79 |
$0.00 |
| D9995 |
|
362 |
318 |
$0.00 |
| 3080F |
|
712 |
633 |
$0.00 |
| D0170 |
|
93 |
91 |
$0.00 |
| 3078F |
|
4,938 |
4,254 |
$0.00 |
| 3077F |
|
1,614 |
1,409 |
$0.00 |
| D0190 |
|
105 |
101 |
$0.00 |