| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
202,980 |
177,684 |
$35.56M |
| G9012 |
Other specified case management service not elsewhere classified |
7,984 |
6,689 |
$1.81M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
57,467 |
52,308 |
$24K |
| 3078F |
|
3,858 |
3,596 |
$5K |
| 3079F |
|
2,329 |
2,245 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16,935 |
15,055 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,999 |
4,855 |
$4K |
| 3074F |
|
3,033 |
2,869 |
$4K |
| 3077F |
|
2,007 |
1,900 |
$4K |
| 3075F |
|
1,420 |
1,371 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
6,185 |
6,043 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,390 |
2,229 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,102 |
2,033 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,590 |
16,479 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
811 |
754 |
$1K |
| 96160 |
|
575 |
550 |
$840.18 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,866 |
1,698 |
$823.48 |
| 92551 |
|
5,597 |
5,403 |
$810.36 |
| 3080F |
|
511 |
486 |
$666.17 |
| D1120 |
Prophylaxis - child |
1,495 |
1,468 |
$570.00 |
| 11721 |
|
1,000 |
952 |
$560.00 |
| 99173 |
|
5,139 |
4,961 |
$527.18 |
| D0120 |
Periodic oral evaluation - established patient |
898 |
884 |
$460.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
877 |
826 |
$411.39 |
| D0140 |
Limited oral evaluation - problem focused |
927 |
883 |
$400.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,214 |
3,983 |
$398.06 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,076 |
1,060 |
$360.00 |
| D1206 |
Topical application of fluoride varnish |
1,954 |
1,917 |
$360.00 |
| T1001 |
Nursing assessment / evaluation |
326 |
320 |
$350.00 |
| 92250 |
|
850 |
813 |
$272.95 |
| 82465 |
|
355 |
344 |
$253.86 |
| 3044F |
|
148 |
139 |
$250.00 |
| D0274 |
Bitewings - four radiographic images |
910 |
887 |
$224.00 |
| 81002 |
|
3,723 |
2,947 |
$209.06 |
| 85018 |
|
1,978 |
1,899 |
$200.82 |
| 99429 |
|
320 |
310 |
$200.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
245 |
$200.00 |
| 90686 |
|
8,999 |
8,222 |
$142.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
323 |
320 |
$135.62 |
| 96127 |
|
2,043 |
1,977 |
$124.79 |
| D1110 |
Prophylaxis - adult |
481 |
474 |
$108.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,576 |
2,172 |
$81.02 |
| 90723 |
|
3,074 |
2,946 |
$80.00 |
| 90647 |
|
3,121 |
2,987 |
$70.00 |
| 92015 |
Determination of refractive state |
3,807 |
3,514 |
$63.00 |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
80 |
79 |
$42.82 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,706 |
6,514 |
$42.00 |
| 90633 |
|
2,900 |
2,769 |
$42.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
509 |
490 |
$32.30 |
| 90696 |
|
993 |
940 |
$30.00 |
| 90710 |
|
1,407 |
1,328 |
$30.00 |
| 90715 |
|
2,586 |
2,433 |
$30.00 |
| 90674 |
|
251 |
227 |
$27.11 |
| 96156 |
|
15 |
14 |
$25.20 |
| 90716 |
|
769 |
729 |
$22.00 |
| 90732 |
|
254 |
238 |
$20.00 |
| 3046F |
|
13 |
13 |
$20.00 |
| 90672 |
|
614 |
514 |
$20.00 |
| 90734 |
|
1,079 |
1,012 |
$20.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,062 |
3,914 |
$18.06 |
| 81025 |
|
704 |
673 |
$12.00 |
| 90651 |
|
2,303 |
2,165 |
$10.00 |
| 90700 |
|
745 |
689 |
$10.00 |
| 90707 |
|
702 |
659 |
$10.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
26 |
25 |
$6.30 |
| D1310 |
|
1,135 |
1,104 |
$5.00 |
| 36416 |
|
6,417 |
6,209 |
$0.00 |
| 82962 |
|
1,536 |
1,461 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
547 |
472 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
171 |
167 |
$0.00 |
| 90680 |
|
2,395 |
2,295 |
$0.00 |
| 90620 |
|
905 |
870 |
$0.00 |
| 4000F |
|
535 |
516 |
$0.00 |
| 96161 |
|
1,792 |
1,712 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
230 |
$0.00 |
| D1330 |
|
1,922 |
1,886 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
2,717 |
2,639 |
$0.00 |
| 90619 |
|
751 |
732 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
72 |
$0.00 |
| D0601 |
|
88 |
82 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
156 |
$0.00 |
| D1351 |
Sealant - per tooth |
17 |
15 |
$0.00 |
| 90677 |
|
982 |
959 |
$0.00 |
| 90660 |
|
169 |
143 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
166 |
152 |
$0.00 |
| 99381 |
|
12 |
12 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
44 |
44 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
29 |
29 |
$0.00 |
| 90656 |
|
848 |
620 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
58 |
54 |
$0.00 |
| D0603 |
|
14 |
12 |
$0.00 |
| D0602 |
|
22 |
17 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| H0049 |
Alcohol and/or drug screening |
14 |
14 |
$0.00 |
| 99051 |
|
1,312 |
1,275 |
$0.00 |
| 90670 |
|
3,654 |
3,490 |
$0.00 |
| 83655 |
|
359 |
347 |
$0.00 |
| D0330 |
Panoramic radiographic image |
875 |
857 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
225 |
207 |
$0.00 |
| 81003 |
|
329 |
304 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
548 |
514 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
951 |
914 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
13 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
38 |
38 |
$0.00 |
| 92133 |
|
13 |
13 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
117 |
114 |
$0.00 |
| 90461 |
|
154 |
144 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
48 |
48 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
28 |
27 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
27 |
25 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |
| 80061 |
Lipid panel |
13 |
13 |
$0.00 |
| 90662 |
|
27 |
25 |
$0.00 |