| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
73,538 |
53,631 |
$10.34M |
| D0999 |
Unspecified diagnostic procedure, by report |
2,275 |
1,749 |
$223K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
211 |
146 |
$15K |
| 0503F |
|
964 |
835 |
$600.00 |
| 0500F |
|
1,452 |
1,383 |
$434.88 |
| 0502F |
|
13,159 |
7,820 |
$266.60 |
| 96127 |
|
26,189 |
17,821 |
$112.60 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,255 |
20,703 |
$41.35 |
| 81025 |
|
8,857 |
7,383 |
$27.22 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
511 |
$21.05 |
| D0230 |
Intraoral - periapical each additional radiographic image |
794 |
758 |
$19.00 |
| 90670 |
|
2,125 |
1,842 |
$13.80 |
| 90647 |
|
1,246 |
1,026 |
$12.80 |
| 90680 |
|
1,352 |
1,166 |
$12.80 |
| 90723 |
|
1,958 |
1,686 |
$12.80 |
| Q3014 |
Telehealth originating site facility fee |
4,085 |
3,509 |
$9.00 |
| 90633 |
|
1,205 |
1,097 |
$7.40 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
497 |
395 |
$7.00 |
| 90707 |
|
184 |
154 |
$6.40 |
| D0220 |
Intraoral - periapical first radiographic image |
882 |
833 |
$5.60 |
| 36415 |
Collection of venous blood by venipuncture |
5,024 |
4,561 |
$5.00 |
| 99173 |
|
3,623 |
3,185 |
$4.00 |
| 97802 |
|
1,815 |
1,587 |
$3.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,729 |
1,537 |
$3.00 |
| 81002 |
|
2,888 |
1,756 |
$2.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,887 |
1,687 |
$2.00 |
| 90686 |
|
1,918 |
1,696 |
$2.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,359 |
4,530 |
$2.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
287 |
209 |
$1.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,106 |
2,645 |
$1.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,835 |
2,536 |
$1.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,978 |
1,714 |
$1.00 |
| 99215 |
Prolong outpt/office vis |
196 |
150 |
$1.00 |
| 90734 |
|
500 |
432 |
$1.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,153 |
2,781 |
$1.00 |
| 90716 |
|
308 |
272 |
$1.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,286 |
1,182 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,601 |
4,011 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,515 |
1,323 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
347 |
250 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
491 |
408 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
266 |
236 |
$0.00 |
| 90715 |
|
44 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
275 |
260 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
428 |
411 |
$0.00 |
| 3077F |
|
27 |
26 |
$0.00 |
| 3078F |
|
2,371 |
2,011 |
$0.00 |
| 90681 |
|
65 |
61 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
15 |
15 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
120 |
116 |
$0.00 |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$0.00 |
| 90710 |
|
58 |
54 |
$0.00 |
| 90700 |
|
27 |
25 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
173 |
164 |
$0.00 |
| 92551 |
|
901 |
865 |
$0.00 |
| 99381 |
|
279 |
245 |
$0.00 |
| 90677 |
|
302 |
287 |
$0.00 |
| 99384 |
|
58 |
51 |
$0.00 |
| 90656 |
|
144 |
135 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
3,238 |
2,692 |
$0.00 |
| 1126F |
|
2,517 |
2,281 |
$0.00 |
| 90696 |
|
60 |
54 |
$0.00 |
| 99383 |
|
79 |
68 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
946 |
332 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
185 |
181 |
$0.00 |
| 3075F |
|
212 |
199 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
247 |
234 |
$0.00 |
| 3079F |
|
618 |
566 |
$0.00 |
| 90620 |
|
43 |
42 |
$0.00 |
| 1125F |
|
212 |
206 |
$0.00 |
| 3074F |
|
2,773 |
2,316 |
$0.00 |
| 3080F |
|
25 |
24 |
$0.00 |
| 90651 |
|
294 |
230 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
104 |
104 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
147 |
136 |
$0.00 |
| 99385 |
|
27 |
27 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
37 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
76 |
67 |
$0.00 |