| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
73,293 |
53,757 |
$10.63M |
| D0999 |
Unspecified diagnostic procedure, by report |
11,460 |
9,611 |
$1.20M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,653 |
1,354 |
$86K |
| 0001A |
|
719 |
607 |
$30K |
| 0002A |
|
717 |
625 |
$30K |
| 0012A |
|
191 |
169 |
$8K |
| 0011A |
|
228 |
200 |
$7K |
| 0072A |
|
164 |
164 |
$7K |
| 0071A |
|
160 |
158 |
$7K |
| 90480 |
|
160 |
159 |
$6K |
| 0004A |
|
126 |
118 |
$5K |
| 0124A |
|
117 |
107 |
$5K |
| 90651 |
|
1,164 |
1,041 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,576 |
15,947 |
$2K |
| 0064A |
|
52 |
51 |
$2K |
| 90734 |
|
828 |
709 |
$2K |
| 0054A |
|
38 |
38 |
$2K |
| D1120 |
Prophylaxis - child |
4,786 |
4,569 |
$1K |
| 0134A |
|
33 |
31 |
$1K |
| 0502F |
|
14,038 |
5,799 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
4,607 |
4,385 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,564 |
8,481 |
$836.80 |
| 90670 |
|
2,217 |
1,973 |
$647.72 |
| 0081A |
|
13 |
12 |
$543.40 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,797 |
4,279 |
$488.10 |
| 90658 |
|
761 |
647 |
$431.39 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,757 |
1,655 |
$416.00 |
| 90620 |
|
352 |
329 |
$345.40 |
| 90715 |
|
1,114 |
1,012 |
$339.88 |
| 90710 |
|
212 |
195 |
$327.41 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
9,006 |
7,958 |
$326.91 |
| 90716 |
|
209 |
193 |
$299.40 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,433 |
3,163 |
$234.61 |
| D1206 |
Topical application of fluoride varnish |
1,738 |
1,675 |
$208.00 |
| D0274 |
Bitewings - four radiographic images |
1,304 |
1,222 |
$191.98 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,192 |
3,625 |
$178.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,365 |
4,048 |
$173.77 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,677 |
3,357 |
$171.52 |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,691 |
1,293 |
$168.75 |
| 90688 |
|
1,317 |
1,240 |
$167.82 |
| D0220 |
Intraoral - periapical first radiographic image |
3,384 |
3,175 |
$152.21 |
| 90633 |
|
1,201 |
1,092 |
$151.11 |
| 0500F |
|
397 |
387 |
$144.96 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,797 |
1,301 |
$144.45 |
| 81025 |
|
2,307 |
1,997 |
$138.12 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,175 |
1,154 |
$130.09 |
| 90696 |
|
200 |
184 |
$127.21 |
| D0272 |
Bitewings - two radiographic images |
1,330 |
1,280 |
$103.40 |
| 59430 |
|
507 |
452 |
$103.00 |
| 90686 |
|
2,070 |
1,967 |
$99.79 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,441 |
1,168 |
$92.55 |
| 85018 |
|
2,247 |
2,011 |
$89.18 |
| 90648 |
|
814 |
724 |
$86.42 |
| 99201 |
|
643 |
551 |
$85.55 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,207 |
1,117 |
$80.35 |
| 90680 |
|
1,680 |
1,521 |
$79.30 |
| 81000 |
|
9,537 |
3,345 |
$67.82 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,598 |
2,421 |
$63.00 |
| 90473 |
|
1,179 |
1,066 |
$60.00 |
| 90677 |
|
390 |
382 |
$59.61 |
| 90832 |
Psychotherapy, 30 minutes with patient |
967 |
741 |
$50.48 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
299 |
297 |
$47.77 |
| 90698 |
|
1,278 |
1,166 |
$45.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$39.12 |
| 90744 |
|
839 |
767 |
$32.01 |
| 90707 |
|
230 |
201 |
$28.80 |
| D0330 |
Panoramic radiographic image |
147 |
147 |
$28.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
114 |
93 |
$11.00 |
| 90723 |
|
372 |
326 |
$10.10 |
| 90791 |
Psychiatric diagnostic evaluation |
575 |
521 |
$8.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
445 |
396 |
$6.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
834 |
810 |
$6.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
930 |
833 |
$4.48 |
| 99215 |
Prolong outpt/office vis |
274 |
255 |
$1.00 |
| 90700 |
|
140 |
115 |
$0.03 |
| 3079F |
|
87 |
85 |
$0.00 |
| 3008F |
|
1,278 |
1,188 |
$0.00 |
| 82962 |
|
48 |
46 |
$0.00 |
| 96127 |
|
936 |
868 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
416 |
367 |
$0.00 |
| 2000F |
|
213 |
198 |
$0.00 |
| 1036F |
|
325 |
317 |
$0.00 |
| D1351 |
Sealant - per tooth |
481 |
218 |
$0.00 |
| 4010F |
|
61 |
59 |
$0.00 |
| 3074F |
|
222 |
208 |
$0.00 |
| 51798 |
|
14 |
14 |
$0.00 |
| 1126F |
|
45 |
42 |
$0.00 |
| 99381 |
|
323 |
295 |
$0.00 |
| 90656 |
|
636 |
621 |
$0.00 |
| 87081 |
|
24 |
24 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| 90619 |
|
151 |
140 |
$0.00 |
| 3075F |
|
13 |
13 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
40 |
38 |
$0.00 |
| 99385 |
|
52 |
52 |
$0.00 |
| 90381 |
|
54 |
50 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
25 |
25 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
29 |
29 |
$0.00 |
| D0603 |
|
48 |
48 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
24 |
$0.00 |
| 96380 |
|
48 |
48 |
$0.00 |
| 86580 |
|
12 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
243 |
238 |
$0.00 |
| 81002 |
|
64 |
63 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,923 |
1,893 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
44 |
44 |
$0.00 |
| 90750 |
|
108 |
97 |
$0.00 |
| 90461 |
|
525 |
507 |
$0.00 |
| 59025 |
Fetal non-stress test |
148 |
76 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
238 |
217 |
$0.00 |
| 3078F |
|
237 |
224 |
$0.00 |
| 1159F |
|
12 |
12 |
$0.00 |
| 3077F |
|
84 |
83 |
$0.00 |
| D1110 |
Prophylaxis - adult |
175 |
167 |
$0.00 |
| 90662 |
|
17 |
13 |
$0.00 |
| 1160F |
|
12 |
12 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
57 |
56 |
$0.00 |
| 99173 |
|
16 |
16 |
$0.00 |
| 4145F |
|
12 |
12 |
$0.00 |