| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
177,231 |
140,044 |
$35.29M |
| D9999 |
Unspecified adjunctive procedure, by report |
30,786 |
28,353 |
$5.94M |
| D0999 |
Unspecified diagnostic procedure, by report |
13,441 |
12,930 |
$3.07M |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
3,363 |
3,352 |
$151K |
| 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 |
4,521 |
3,729 |
$139K |
| D1206 |
Topical application of fluoride varnish |
15,952 |
15,565 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
10,723 |
10,459 |
$28K |
| D1110 |
Prophylaxis - adult |
9,304 |
9,149 |
$23K |
| D1120 |
Prophylaxis - child |
8,289 |
8,076 |
$22K |
| D0274 |
Bitewings - four radiographic images |
8,859 |
8,680 |
$16K |
| D1999 |
|
202 |
189 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,237 |
971 |
$13K |
| D1351 |
Sealant - per tooth |
6,836 |
1,975 |
$13K |
| D0330 |
Panoramic radiographic image |
4,513 |
4,397 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
3,226 |
3,133 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,731 |
5,609 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,333 |
1,004 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
89,865 |
77,271 |
$5K |
| D0190 |
|
5,439 |
5,394 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31,239 |
28,523 |
$4K |
| 3074F |
|
14,330 |
12,671 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,684 |
4,982 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
11,223 |
10,716 |
$3K |
| 3078F |
|
12,751 |
11,450 |
$3K |
| D0272 |
Bitewings - two radiographic images |
2,714 |
2,638 |
$3K |
| 3079F |
|
4,999 |
4,546 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
4,803 |
4,596 |
$2K |
| 3077F |
|
2,474 |
2,238 |
$2K |
| 3075F |
|
2,732 |
2,531 |
$2K |
| 90686 |
|
11,000 |
10,792 |
$1K |
| 3044F |
|
668 |
651 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
20,152 |
19,677 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,040 |
1,015 |
$856.74 |
| 3051F |
|
177 |
174 |
$583.82 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
9,067 |
8,891 |
$546.08 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
5,340 |
4,913 |
$536.56 |
| 3048F |
|
539 |
525 |
$522.08 |
| D0603 |
|
1,629 |
1,592 |
$425.00 |
| D4355 |
|
339 |
332 |
$411.63 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$400.11 |
| 90649 |
|
233 |
229 |
$360.00 |
| 71046 |
Radiologic examination, chest; 2 views |
1,729 |
1,659 |
$331.47 |
| D7140 |
Extraction, erupted tooth or exposed root |
887 |
558 |
$305.48 |
| 3052F |
|
80 |
78 |
$300.00 |
| D0601 |
|
1,579 |
1,546 |
$260.01 |
| 90651 |
|
3,127 |
3,059 |
$237.96 |
| D0145 |
Oral evaluation for a patient under three years of age |
321 |
315 |
$221.59 |
| 3049F |
|
280 |
275 |
$220.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
6,784 |
6,680 |
$158.66 |
| 90716 |
|
1,571 |
1,531 |
$138.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
221 |
209 |
$120.00 |
| 90791 |
Psychiatric diagnostic evaluation |
559 |
517 |
$103.04 |
| 90734 |
|
2,177 |
2,117 |
$85.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
7,075 |
6,975 |
$79.60 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,555 |
6,243 |
$73.26 |
| 93000 |
|
1,722 |
1,680 |
$63.78 |
| 3050F |
|
184 |
182 |
$60.00 |
| 90662 |
|
209 |
207 |
$55.00 |
| 72110 |
|
238 |
234 |
$44.24 |
| 90732 |
|
141 |
141 |
$44.00 |
| 90715 |
|
1,405 |
1,371 |
$40.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,755 |
1,529 |
$33.93 |
| 73562 |
|
259 |
205 |
$27.36 |
| 73030 |
|
53 |
51 |
$18.10 |
| 81025 |
|
241 |
229 |
$17.94 |
| 69209 |
|
18 |
13 |
$10.94 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,005 |
925 |
$9.96 |
| 36415 |
Collection of venous blood by venipuncture |
1,004 |
943 |
$6.34 |
| D1354 |
|
45 |
17 |
$0.15 |
| D0270 |
|
13 |
12 |
$0.05 |
| D9110 |
|
119 |
112 |
$0.03 |
| D2940 |
|
18 |
12 |
$0.02 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,685 |
4,573 |
$0.00 |
| 3353F |
|
606 |
570 |
$0.00 |
| 90696 |
|
1,142 |
1,117 |
$0.00 |
| 99460 |
|
1,530 |
1,453 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
3,058 |
2,946 |
$0.00 |
| 92551 |
|
2,981 |
2,925 |
$0.00 |
| 2000F |
|
19,446 |
16,693 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,529 |
1,038 |
$0.00 |
| 99462 |
|
752 |
594 |
$0.00 |
| 90723 |
|
2,746 |
2,698 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,106 |
3,875 |
$0.00 |
| 3352F |
|
844 |
803 |
$0.00 |
| A9150 |
Non-prescription drugs |
2,687 |
2,526 |
$0.00 |
| 90647 |
|
3,061 |
3,000 |
$0.00 |
| D1330 |
|
2,623 |
2,513 |
$0.00 |
| 4037F |
|
2,474 |
2,432 |
$0.00 |
| 90381 |
|
14 |
14 |
$0.00 |
| 90620 |
|
240 |
239 |
$0.00 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
1,898 |
1,825 |
$0.00 |
| D1352 |
|
143 |
90 |
$0.00 |
| 2010F |
|
24,265 |
20,510 |
$0.00 |
| 99384 |
|
196 |
192 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,137 |
6,006 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
919 |
831 |
$0.00 |
| 3351F |
|
6,679 |
6,399 |
$0.00 |
| 90697 |
|
448 |
444 |
$0.00 |
| 2001F |
|
23,792 |
20,185 |
$0.00 |
| 96127 |
|
21 |
21 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
203 |
182 |
$0.00 |
| 90677 |
|
831 |
826 |
$0.00 |
| 4010F |
|
2,810 |
2,231 |
$0.00 |
| 90680 |
|
558 |
550 |
$0.00 |
| 3060F |
|
38 |
38 |
$0.00 |
| 3080F |
|
1,787 |
1,622 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
332 |
327 |
$0.00 |
| 1034F |
|
5,909 |
4,878 |
$0.00 |
| 3008F |
|
20,709 |
17,769 |
$0.00 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
82 |
78 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
153 |
143 |
$0.00 |
| 3061F |
|
88 |
84 |
$0.00 |
| 90619 |
|
417 |
412 |
$0.00 |
| 99383 |
|
181 |
178 |
$0.00 |
| 1126F |
|
3,446 |
3,257 |
$0.00 |
| 99381 |
|
170 |
162 |
$0.00 |
| 99385 |
|
67 |
66 |
$0.00 |
| 1036F |
|
14,974 |
12,663 |
$0.00 |
| 90480 |
|
898 |
880 |
$0.00 |
| 1125F |
|
5,365 |
4,805 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
25 |
25 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
12 |
12 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
15 |
14 |
$0.00 |
| D9994 |
|
45 |
44 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
38 |
29 |
$0.00 |
| 90656 |
|
1,045 |
1,036 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
12 |
12 |
$0.00 |
| 81001 |
|
13 |
12 |
$0.00 |
| 90839 |
|
12 |
12 |
$0.00 |
| 96380 |
|
28 |
27 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
6,314 |
5,838 |
$0.00 |
| 90707 |
|
1,480 |
1,449 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
5,417 |
5,322 |
$0.00 |
| 90633 |
|
3,197 |
3,131 |
$0.00 |
| 4004F |
|
5,440 |
4,942 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
3,042 |
2,938 |
$0.00 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
1,796 |
1,706 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
7,670 |
7,531 |
$0.00 |
| 87631 |
|
176 |
167 |
$0.00 |
| 1160F |
|
19,503 |
16,452 |
$0.00 |
| 4274F |
|
9,704 |
7,753 |
$0.00 |
| 90710 |
|
1,280 |
1,257 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
4,944 |
4,700 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
2,837 |
1,686 |
$0.00 |
| 4040F |
|
3,381 |
2,716 |
$0.00 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
649 |
608 |
$0.00 |
| 90750 |
|
777 |
765 |
$0.00 |
| 99173 |
|
3,723 |
3,658 |
$0.00 |
| 54150 |
|
353 |
334 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,999 |
1,922 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
258 |
248 |
$0.00 |
| 3046F |
|
193 |
189 |
$0.00 |
| 90473 |
|
863 |
843 |
$0.00 |
| 90670 |
|
4,241 |
4,167 |
$0.00 |
| 2028F |
|
292 |
286 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
98 |
75 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
12 |
12 |
$0.00 |
| 90746 |
|
41 |
41 |
$0.00 |
| 80305 |
|
580 |
415 |
$0.00 |
| 91321 |
|
138 |
136 |
$0.00 |
| 90714 |
|
14 |
14 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
782 |
737 |
$0.00 |
| 90736 |
|
51 |
51 |
$0.00 |
| 90380 |
|
14 |
13 |
$0.00 |
| 99188 |
|
13 |
13 |
$0.00 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
204 |
204 |
$0.00 |
| 90700 |
|
154 |
153 |
$0.00 |
| 99382 |
|
81 |
80 |
$0.00 |
| 73130 |
|
12 |
12 |
$0.00 |
| 91322 |
|
412 |
405 |
$0.00 |
| 91320 |
|
145 |
138 |
$0.00 |
| 90671 |
|
294 |
287 |
$0.00 |
| 1159F |
|
19,503 |
16,452 |
$0.00 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
14 |
12 |
$0.00 |
| 82947 |
|
12 |
12 |
$0.00 |
| 99201 |
|
27 |
26 |
$0.00 |
| 17110 |
|
32 |
29 |
$0.00 |
| 99397 |
|
28 |
26 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
44 |
41 |
$0.00 |
| 81003 |
|
13 |
13 |
$0.00 |
| D2140 |
|
19 |
13 |
$0.00 |
| S0119 |
Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) |
15 |
15 |
$0.00 |