| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
41,914 |
32,539 |
$6.74M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33,151 |
25,445 |
$538K |
| D0999 |
Unspecified diagnostic procedure, by report |
6,459 |
5,483 |
$427K |
| D1120 |
Prophylaxis - child |
4,702 |
4,086 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,011 |
3,623 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
3,242 |
2,871 |
$88K |
| D1110 |
Prophylaxis - adult |
2,508 |
2,251 |
$83K |
| D0330 |
Panoramic radiographic image |
2,326 |
2,133 |
$81K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
1,980 |
1,865 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,436 |
5,638 |
$65K |
| D9999 |
Unspecified adjunctive procedure, by report |
282 |
259 |
$57K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,290 |
1,180 |
$50K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,226 |
1,140 |
$47K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,151 |
3,859 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,008 |
3,581 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,425 |
1,289 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
586 |
271 |
$30K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,975 |
3,266 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,362 |
2,103 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,545 |
2,061 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
3,054 |
2,600 |
$22K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,214 |
2,061 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,357 |
1,177 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
238 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
582 |
540 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
204 |
$10K |
| 90686 |
|
700 |
662 |
$10K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
223 |
213 |
$10K |
| 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 |
2,288 |
1,503 |
$9K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,802 |
1,413 |
$8K |
| 76830 |
Ultrasound, transvaginal |
158 |
147 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
821 |
687 |
$6K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
134 |
96 |
$5K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
2,360 |
1,941 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
209 |
192 |
$3K |
| 90670 |
|
634 |
599 |
$3K |
| 90837 |
Psychotherapy, 53 minutes with patient |
222 |
86 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
57 |
53 |
$1K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
316 |
278 |
$903.17 |
| 90677 |
|
112 |
108 |
$865.48 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$690.39 |
| 90656 |
|
37 |
37 |
$336.37 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
54 |
53 |
$237.12 |
| 90648 |
|
459 |
423 |
$173.91 |
| 90474 |
|
40 |
36 |
$117.60 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
17 |
13 |
$48.88 |
| 90723 |
|
286 |
263 |
$36.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
116 |
111 |
$0.01 |
| 3008F |
|
224 |
207 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| 3074F |
|
423 |
389 |
$0.00 |
| 90647 |
|
98 |
96 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
16 |
13 |
$0.00 |
| 90651 |
|
75 |
73 |
$0.00 |
| 3079F |
|
30 |
26 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
27 |
19 |
$0.00 |
| 3078F |
|
256 |
242 |
$0.00 |
| 90633 |
|
86 |
84 |
$0.00 |
| 90734 |
|
117 |
107 |
$0.00 |
| 90710 |
|
67 |
65 |
$0.00 |
| 90715 |
|
52 |
50 |
$0.00 |
| 90681 |
|
39 |
36 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
16 |
15 |
$0.00 |