| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
234,758 |
167,981 |
$32.13M |
| D0999 |
Unspecified diagnostic procedure, by report |
17,283 |
13,475 |
$1.72M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,961 |
1,238 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,352 |
3,834 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,981 |
2,663 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
2,013 |
1,723 |
$5K |
| 90734 |
|
3,880 |
3,104 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
902 |
703 |
$4K |
| 90651 |
|
4,806 |
4,236 |
$4K |
| D1110 |
Prophylaxis - adult |
1,156 |
979 |
$2K |
| D1120 |
Prophylaxis - child |
2,800 |
2,525 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
838 |
638 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
103,346 |
80,396 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
3,105 |
2,665 |
$2K |
| 90716 |
|
5,094 |
4,431 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,227 |
832 |
$2K |
| 90670 |
|
6,913 |
6,050 |
$1K |
| 90707 |
|
5,064 |
4,430 |
$999.18 |
| 90715 |
|
3,939 |
3,421 |
$777.38 |
| 90791 |
Psychiatric diagnostic evaluation |
2,531 |
2,075 |
$774.41 |
| 90686 |
|
6,637 |
5,879 |
$694.61 |
| 90698 |
|
4,951 |
4,319 |
$677.67 |
| 90633 |
|
5,030 |
4,394 |
$560.86 |
| 3074F |
|
15,742 |
12,360 |
$511.00 |
| D0330 |
Panoramic radiographic image |
1,853 |
1,585 |
$420.57 |
| D0274 |
Bitewings - four radiographic images |
3,624 |
3,183 |
$401.80 |
| 3078F |
|
13,456 |
10,714 |
$384.00 |
| 90680 |
|
2,295 |
2,070 |
$360.66 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25,735 |
20,071 |
$324.05 |
| 90744 |
|
2,976 |
2,562 |
$247.02 |
| 3079F |
|
4,525 |
3,578 |
$239.00 |
| 90696 |
|
2,033 |
1,803 |
$238.44 |
| 0001A |
|
14 |
14 |
$237.16 |
| 90832 |
Psychotherapy, 30 minutes with patient |
7,456 |
4,505 |
$225.10 |
| 0503F |
|
364 |
357 |
$225.00 |
| 3044F |
|
6,467 |
4,229 |
$225.00 |
| D0272 |
Bitewings - two radiographic images |
797 |
725 |
$208.34 |
| 90834 |
Psychotherapy, 45 minutes with patient |
368 |
249 |
$198.90 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,900 |
3,375 |
$181.14 |
| 3080F |
|
2,708 |
2,029 |
$154.00 |
| 3075F |
|
2,447 |
1,935 |
$134.00 |
| 3077F |
|
2,440 |
1,854 |
$132.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
22,153 |
20,080 |
$127.97 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,765 |
2,150 |
$112.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,385 |
7,497 |
$111.02 |
| 90713 |
|
468 |
409 |
$94.12 |
| 90700 |
|
1,101 |
967 |
$90.72 |
| 90619 |
|
1,662 |
1,639 |
$83.55 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
8,189 |
7,122 |
$76.84 |
| 81025 |
|
10,125 |
8,581 |
$69.67 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,742 |
1,417 |
$66.62 |
| 81002 |
|
2,949 |
2,510 |
$60.60 |
| 90685 |
|
425 |
328 |
$53.20 |
| 90648 |
|
372 |
320 |
$38.20 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
4,861 |
4,148 |
$32.00 |
| 3051F |
|
235 |
153 |
$13.00 |
| 90697 |
|
1,995 |
1,920 |
$10.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
4,646 |
4,305 |
$10.00 |
| 82962 |
|
3,920 |
3,192 |
$8.00 |
| 3046F |
|
630 |
388 |
$7.00 |
| 90681 |
|
1,903 |
1,757 |
$6.40 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
553 |
539 |
$0.00 |
| 90474 |
|
2,460 |
2,203 |
$0.00 |
| 99385 |
|
389 |
330 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,943 |
3,540 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,051 |
932 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,145 |
1,027 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
869 |
743 |
$0.00 |
| 90620 |
|
520 |
508 |
$0.00 |
| 99381 |
|
2,099 |
1,977 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
309 |
$0.00 |
| 90656 |
|
93 |
84 |
$0.00 |
| 90677 |
|
1,117 |
1,093 |
$0.00 |
| 0500F |
|
1,354 |
1,324 |
$0.00 |
| 86580 |
|
419 |
320 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
24,430 |
20,783 |
$0.00 |
| 90674 |
|
41 |
41 |
$0.00 |
| 99383 |
|
1,153 |
935 |
$0.00 |
| 3052F |
|
140 |
94 |
$0.00 |
| 99386 |
|
86 |
76 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
108 |
93 |
$0.00 |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
124 |
95 |
$0.00 |
| 99384 |
|
418 |
299 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
75 |
55 |
$0.00 |
| D1351 |
Sealant - per tooth |
232 |
93 |
$0.00 |
| D0601 |
|
68 |
43 |
$0.00 |
| 90381 |
|
41 |
40 |
$0.00 |
| 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 |
39 |
36 |
$0.00 |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
114 |
103 |
$0.00 |
| 59430 |
|
15 |
14 |
$0.00 |
| D4355 |
|
30 |
26 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
19 |
13 |
$0.00 |
| 90688 |
|
35 |
34 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| 0502F |
|
5,124 |
3,505 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,602 |
2,178 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,770 |
1,468 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
7,732 |
6,960 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
201 |
127 |
$0.00 |
| 99201 |
|
470 |
369 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
849 |
819 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
11,895 |
10,207 |
$0.00 |
| 99173 |
|
2,178 |
1,568 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,646 |
1,410 |
$0.00 |
| 90461 |
|
2,236 |
2,202 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
5,645 |
4,869 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,135 |
4,045 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,675 |
1,577 |
$0.00 |
| 99382 |
|
557 |
433 |
$0.00 |
| 99078 |
|
14 |
12 |
$0.00 |
| 3045F |
|
15 |
12 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
305 |
261 |
$0.00 |
| 91312 |
|
14 |
14 |
$0.00 |
| D9110 |
|
56 |
48 |
$0.00 |
| 90658 |
|
33 |
33 |
$0.00 |
| 98960 |
|
20 |
16 |
$0.00 |
| 90661 |
|
246 |
240 |
$0.00 |
| 90687 |
|
56 |
55 |
$0.00 |
| 90672 |
|
16 |
16 |
$0.00 |
| D4341 |
|
35 |
12 |
$0.00 |
| 90380 |
|
26 |
26 |
$0.00 |