| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G9012 |
Other specified case management service not elsewhere classified |
7,246 |
5,158 |
$2.18M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,264 |
10,308 |
$226K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,255 |
6,535 |
$127K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,222 |
2,227 |
$61K |
| G9008 |
Coordinated care fee, physician coordinated care oversight services |
6,402 |
2,817 |
$53K |
| 90791 |
Psychiatric diagnostic evaluation |
1,041 |
1,040 |
$38K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
998 |
938 |
$34K |
| 59425 |
|
497 |
334 |
$27K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
392 |
271 |
$23K |
| V2020 |
Frames, purchases |
4,273 |
4,266 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,937 |
3,930 |
$18K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,673 |
1,128 |
$14K |
| 92551 |
|
2,478 |
2,466 |
$14K |
| D1120 |
Prophylaxis - child |
234 |
234 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,443 |
1,443 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,060 |
1,057 |
$9K |
| D1351 |
Sealant - per tooth |
215 |
117 |
$8K |
| 92015 |
Determination of refractive state |
4,520 |
4,516 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,311 |
3,074 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
567 |
563 |
$7K |
| 85018 |
|
3,479 |
3,444 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
108 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
309 |
308 |
$5K |
| 81002 |
|
2,308 |
2,065 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
59 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
156 |
156 |
$4K |
| D1206 |
Topical application of fluoride varnish |
148 |
146 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
722 |
722 |
$3K |
| 90686 |
|
1,723 |
1,719 |
$3K |
| D0274 |
Bitewings - four radiographic images |
124 |
124 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
184 |
143 |
$3K |
| 81025 |
|
990 |
925 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
59 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
47 |
$2K |
| 90651 |
|
117 |
117 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
906 |
624 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
327 |
326 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
130 |
130 |
$2K |
| D1352 |
|
37 |
27 |
$1K |
| 82948 |
|
588 |
543 |
$1K |
| 90688 |
|
203 |
203 |
$1K |
| 99173 |
|
1,946 |
1,939 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
33 |
33 |
$1K |
| 90715 |
|
61 |
61 |
$965.94 |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
52 |
$670.80 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$577.21 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$533.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
57 |
57 |
$454.58 |
| 92341 |
|
29 |
29 |
$257.58 |
| 99401 |
|
17 |
15 |
$193.45 |
| 92133 |
|
13 |
13 |
$128.60 |
| 86580 |
|
37 |
37 |
$107.33 |
| 92002 |
|
13 |
13 |
$88.56 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
14 |
14 |
$70.42 |
| 98940 |
|
109 |
65 |
$16.72 |
| 90461 |
|
72 |
71 |
$0.00 |
| 90633 |
|
15 |
15 |
$0.00 |
| 90734 |
|
27 |
27 |
$0.00 |
| 90656 |
|
18 |
18 |
$0.00 |