| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
97,840 |
80,237 |
$7.62M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
57,327 |
32,213 |
$1.17M |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
50,979 |
23,061 |
$625K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14,505 |
8,285 |
$429K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12,702 |
7,510 |
$385K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12,331 |
7,011 |
$291K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
9,712 |
5,533 |
$286K |
| D1120 |
Prophylaxis - child |
22,254 |
13,944 |
$259K |
| D1206 |
Topical application of fluoride varnish |
24,011 |
15,009 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
21,193 |
13,136 |
$214K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,733 |
2,640 |
$152K |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,504 |
3,376 |
$131K |
| D0330 |
Panoramic radiographic image |
4,794 |
3,221 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,890 |
4,460 |
$105K |
| D1110 |
Prophylaxis - adult |
4,021 |
2,498 |
$80K |
| D0274 |
Bitewings - four radiographic images |
7,314 |
4,703 |
$66K |
| D0272 |
Bitewings - two radiographic images |
10,648 |
6,579 |
$56K |
| 92551 |
|
14,864 |
8,498 |
$48K |
| D2140 |
|
2,341 |
974 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,663 |
810 |
$40K |
| 99381 |
|
2,194 |
1,528 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,537 |
766 |
$38K |
| D1354 |
|
3,566 |
800 |
$35K |
| D1351 |
Sealant - per tooth |
2,131 |
580 |
$31K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,942 |
1,058 |
$23K |
| 0012A |
|
973 |
569 |
$17K |
| 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 |
1,488 |
1,312 |
$16K |
| 0011A |
|
881 |
491 |
$14K |
| 0002A |
|
645 |
356 |
$13K |
| 0001A |
|
604 |
332 |
$13K |
| 0072A |
|
532 |
291 |
$13K |
| 0071A |
|
552 |
301 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
4,139 |
2,600 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
951 |
589 |
$11K |
| 90834 |
Psychotherapy, 45 minutes with patient |
429 |
198 |
$11K |
| 85018 |
|
9,379 |
5,464 |
$10K |
| 0013A |
|
358 |
196 |
$8K |
| 99215 |
Prolong outpt/office vis |
124 |
87 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
301 |
190 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,376 |
1,255 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
141 |
72 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
154 |
$5K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
631 |
370 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
537 |
289 |
$3K |
| 90674 |
|
386 |
231 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
484 |
453 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
766 |
525 |
$3K |
| 0052A |
|
135 |
70 |
$2K |
| 0003A |
|
76 |
47 |
$2K |
| 81002 |
|
1,546 |
962 |
$2K |
| 99383 |
|
44 |
25 |
$1K |
| 90791 |
Psychiatric diagnostic evaluation |
27 |
16 |
$1K |
| 0054A |
|
78 |
43 |
$1K |
| 90670 |
|
11,189 |
6,554 |
$1K |
| 81025 |
|
431 |
280 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
29 |
12 |
$1K |
| 99384 |
|
41 |
25 |
$1K |
| 0051A |
|
61 |
32 |
$1K |
| 99188 |
|
103 |
72 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
34 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
487 |
326 |
$995.75 |
| 90656 |
|
371 |
368 |
$898.38 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
267 |
175 |
$809.32 |
| D2160 |
|
40 |
25 |
$780.00 |
| 90715 |
|
1,090 |
683 |
$684.21 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
75 |
55 |
$673.51 |
| 90686 |
|
18,313 |
10,767 |
$659.68 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
19 |
12 |
$641.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
41 |
$594.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
23 |
12 |
$586.62 |
| 0064A |
|
23 |
13 |
$510.68 |
| 0134A |
|
30 |
17 |
$506.50 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
66 |
34 |
$411.30 |
| 81003 |
|
415 |
202 |
$399.06 |
| 90688 |
|
41 |
22 |
$367.48 |
| 0111A |
|
21 |
12 |
$308.80 |
| D0350 |
|
12 |
12 |
$282.24 |
| 1111F |
|
12,599 |
7,029 |
$275.00 |
| 90647 |
|
7,448 |
4,575 |
$266.43 |
| 90651 |
|
3,385 |
2,056 |
$258.04 |
| 90723 |
|
6,759 |
4,083 |
$224.98 |
| 90681 |
|
5,451 |
3,163 |
$179.40 |
| 90734 |
|
2,405 |
1,436 |
$134.42 |
| 91301 |
|
2,353 |
1,350 |
$110.52 |
| 82962 |
|
48 |
24 |
$63.66 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
100 |
86 |
$55.01 |
| 96127 |
|
12 |
12 |
$35.73 |
| 3077F |
|
1,826 |
1,068 |
$34.88 |
| 86580 |
|
17 |
12 |
$18.83 |
| 90633 |
|
5,982 |
3,683 |
$16.07 |
| 90700 |
|
1,958 |
1,160 |
$12.10 |
| 99172 |
|
129 |
129 |
$9.94 |
| 91300 |
|
1,298 |
651 |
$5.45 |
| 90620 |
|
537 |
302 |
$5.43 |
| 91307 |
|
1,186 |
595 |
$5.14 |
| 90473 |
|
21 |
21 |
$5.00 |
| 90716 |
|
1,873 |
1,185 |
$2.01 |
| 90707 |
|
1,777 |
1,081 |
$1.90 |
| 90710 |
|
1,399 |
862 |
$1.83 |
| 91305 |
|
352 |
210 |
$1.75 |
| 90696 |
|
1,113 |
668 |
$1.23 |
| 91311 |
|
115 |
64 |
$0.46 |
| 91313 |
|
27 |
17 |
$0.10 |
| 91306 |
|
22 |
12 |
$0.09 |
| 90713 |
|
21 |
12 |
$0.01 |
| 3078F |
|
35,293 |
19,707 |
$0.00 |
| 99173 |
|
3,369 |
3,191 |
$0.00 |
| 4004F |
|
1,190 |
689 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
26,928 |
14,605 |
$0.00 |
| 90671 |
|
768 |
552 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
1,446 |
816 |
$0.00 |
| 0502F |
|
122 |
56 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
25 |
14 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
27,472 |
14,922 |
$0.00 |
| 3079F |
|
5,065 |
2,918 |
$0.00 |
| 1036F |
|
25,536 |
14,185 |
$0.00 |
| 3074F |
|
37,608 |
20,929 |
$0.00 |
| 3008F |
|
48,176 |
27,013 |
$0.00 |
| 3080F |
|
678 |
394 |
$0.00 |
| 2001F |
|
48,261 |
27,014 |
$0.00 |
| 3075F |
|
1,688 |
987 |
$0.00 |
| 1034F |
|
4,482 |
2,498 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
729 |
400 |
$0.00 |
| 1035F |
|
3,784 |
2,099 |
$0.00 |
| 90697 |
|
2,304 |
1,214 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,176 |
642 |
$0.00 |
| 3048F |
|
31 |
25 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
20 |
12 |
$0.00 |
| 90677 |
|
51 |
49 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
74 |
72 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
97 |
53 |
$0.00 |