| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,786 |
12,443 |
$1.62M |
| 99199 |
Unlisted special service, procedure or report |
84,009 |
49,079 |
$476K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
978 |
815 |
$75K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
704 |
543 |
$62K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
710 |
585 |
$57K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
701 |
580 |
$49K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,774 |
1,416 |
$39K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,907 |
3,097 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
360 |
318 |
$6K |
| 85018 |
|
3,580 |
3,055 |
$6K |
| 0071A |
|
94 |
68 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
508 |
473 |
$5K |
| 92552 |
|
750 |
651 |
$5K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
128 |
118 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
337 |
322 |
$4K |
| 0072A |
|
54 |
43 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
253 |
234 |
$3K |
| D1110 |
Prophylaxis - adult |
128 |
118 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
205 |
$2K |
| D1120 |
Prophylaxis - child |
127 |
111 |
$2K |
| 81003 |
|
1,540 |
1,328 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
116 |
$1K |
| 96127 |
|
397 |
349 |
$1K |
| 99173 |
|
1,845 |
1,656 |
$784.38 |
| 0002A |
|
15 |
13 |
$727.44 |
| 0001A |
|
14 |
14 |
$679.95 |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
50 |
$677.70 |
| 0011A |
|
12 |
12 |
$650.00 |
| 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 |
62 |
56 |
$593.85 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
31 |
$588.45 |
| 4274F |
|
1,739 |
1,466 |
$543.40 |
| 0012A |
|
12 |
12 |
$520.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
83 |
79 |
$395.56 |
| D0274 |
Bitewings - four radiographic images |
32 |
26 |
$355.25 |
| 96161 |
|
130 |
121 |
$250.58 |
| 36415 |
Collection of venous blood by venipuncture |
84 |
66 |
$158.04 |
| 90674 |
|
644 |
524 |
$107.04 |
| 92551 |
|
1,104 |
998 |
$103.66 |
| 80305 |
|
19 |
12 |
$94.89 |
| 90661 |
|
127 |
125 |
$65.30 |
| 1160F |
|
4,073 |
3,440 |
$26.94 |
| 90686 |
|
583 |
433 |
$19.56 |
| 96160 |
|
30 |
30 |
$18.70 |
| 91300 |
|
95 |
67 |
$5.52 |
| 3074F |
|
5,716 |
4,656 |
$1.65 |
| 3078F |
|
4,874 |
3,980 |
$1.26 |
| 3008F |
|
8,115 |
6,604 |
$1.21 |
| 1159F |
|
4,073 |
3,440 |
$1.02 |
| 3079F |
|
686 |
612 |
$0.32 |
| 3044F |
|
25 |
24 |
$0.02 |
| 3075F |
|
61 |
49 |
$0.01 |
| 90700 |
|
27 |
25 |
$0.00 |
| 4040F |
|
981 |
815 |
$0.00 |
| 90681 |
|
28 |
27 |
$0.00 |
| 90658 |
|
30 |
27 |
$0.00 |
| 4004F |
|
682 |
590 |
$0.00 |
| 90671 |
|
53 |
44 |
$0.00 |
| 90633 |
|
53 |
41 |
$0.00 |
| 90670 |
|
194 |
137 |
$0.00 |
| 90713 |
|
14 |
12 |
$0.00 |
| 80061 |
Lipid panel |
26 |
24 |
$0.00 |
| 99408 |
|
68 |
51 |
$0.00 |
| G8780 |
Counseling for diet and physical activity performed |
42 |
41 |
$0.00 |
| 83655 |
|
18 |
12 |
$0.00 |
| 90734 |
|
16 |
12 |
$0.00 |
| 1036F |
|
3,986 |
3,370 |
$0.00 |
| 2010F |
|
5,678 |
4,753 |
$0.00 |
| 3351F |
|
1,097 |
918 |
$0.00 |
| 2001F |
|
5,654 |
4,732 |
$0.00 |
| 90677 |
|
146 |
142 |
$0.00 |
| 2000F |
|
4,207 |
3,589 |
$0.00 |
| 4037F |
|
1,003 |
791 |
$0.00 |
| 3066F |
|
192 |
182 |
$0.00 |
| D1330 |
|
190 |
159 |
$0.00 |
| 91301 |
|
36 |
36 |
$0.00 |
| 1034F |
|
135 |
119 |
$0.00 |
| 90723 |
|
160 |
139 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
14 |
12 |
$0.00 |
| 90651 |
|
56 |
41 |
$0.00 |
| 90647 |
|
141 |
119 |
$0.00 |
| D0603 |
|
21 |
15 |
$0.00 |
| D0602 |
|
25 |
16 |
$0.00 |
| 4010F |
|
16 |
12 |
$0.00 |
| 90619 |
|
19 |
16 |
$0.00 |
| 1220F |
|
33 |
29 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
20 |
12 |
$0.00 |
| 91307 |
|
152 |
104 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
23 |
15 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
16 |
15 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
16 |
14 |
$0.00 |
| D0601 |
|
30 |
19 |
$0.00 |
| 90680 |
|
19 |
12 |
$0.00 |