| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
113,124 |
98,840 |
$21.10M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
49,342 |
44,755 |
$13K |
| 3074F |
|
17,692 |
16,703 |
$12K |
| 3078F |
|
14,171 |
13,447 |
$12K |
| 3079F |
|
6,048 |
5,759 |
$10K |
| 3077F |
|
1,672 |
1,546 |
$7K |
| 3075F |
|
1,957 |
1,887 |
$5K |
| 3080F |
|
1,099 |
1,035 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,705 |
1,689 |
$2K |
| 0072A |
|
51 |
51 |
$2K |
| 0071A |
|
39 |
39 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,022 |
7,645 |
$1K |
| 92551 |
|
2,466 |
2,428 |
$898.70 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
847 |
842 |
$893.53 |
| 99173 |
|
4,159 |
4,105 |
$881.92 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,057 |
1,849 |
$779.49 |
| 0002A |
|
26 |
26 |
$760.00 |
| 0004A |
|
16 |
16 |
$560.00 |
| 0013A |
|
16 |
16 |
$480.00 |
| 90686 |
|
1,939 |
1,827 |
$447.82 |
| 0001A |
|
12 |
12 |
$440.00 |
| 0003A |
|
18 |
18 |
$400.00 |
| D0330 |
Panoramic radiographic image |
1,011 |
990 |
$314.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,267 |
1,256 |
$281.99 |
| 99384 |
|
27 |
26 |
$191.00 |
| 0051A |
|
16 |
12 |
$160.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
518 |
415 |
$152.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
649 |
633 |
$139.76 |
| D0120 |
Periodic oral evaluation - established patient |
1,539 |
1,528 |
$102.00 |
| D1206 |
Topical application of fluoride varnish |
1,176 |
1,159 |
$96.00 |
| 3725F |
|
3,776 |
3,634 |
$80.00 |
| 0124A |
|
13 |
12 |
$80.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
908 |
$76.00 |
| 80305 |
|
1,955 |
1,636 |
$71.82 |
| D1110 |
Prophylaxis - adult |
1,342 |
1,330 |
$59.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
969 |
951 |
$54.25 |
| D1120 |
Prophylaxis - child |
533 |
524 |
$44.00 |
| 90658 |
|
335 |
334 |
$43.72 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,701 |
3,615 |
$35.83 |
| D0272 |
Bitewings - two radiographic images |
195 |
192 |
$28.00 |
| 90461 |
|
1,810 |
1,764 |
$27.78 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
523 |
507 |
$23.31 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
237 |
232 |
$22.70 |
| 81002 |
|
476 |
459 |
$13.92 |
| D1330 |
|
2,491 |
2,438 |
$0.01 |
| 3008F |
|
18,774 |
17,684 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
770 |
731 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
162 |
$0.00 |
| 1036F |
|
10,123 |
9,448 |
$0.00 |
| 90723 |
|
63 |
63 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,063 |
1,037 |
$0.00 |
| 1034F |
|
4,609 |
4,047 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
340 |
321 |
$0.00 |
| D0603 |
|
262 |
255 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
92 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$0.00 |
| 96127 |
|
814 |
776 |
$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 |
163 |
103 |
$0.00 |
| 90674 |
|
235 |
180 |
$0.00 |
| 90651 |
|
71 |
71 |
$0.00 |
| 1000F |
|
82 |
78 |
$0.00 |
| 99462 |
|
12 |
12 |
$0.00 |
| 90677 |
|
15 |
15 |
$0.00 |
| 90480 |
|
19 |
19 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
16 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
88 |
$0.00 |
| D1351 |
Sealant - per tooth |
29 |
16 |
$0.00 |
| 96161 |
|
40 |
39 |
$0.00 |
| 90696 |
|
26 |
26 |
$0.00 |
| 85018 |
|
19 |
19 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
25 |
24 |
$0.00 |
| D1310 |
|
19 |
19 |
$0.00 |
| 91307 |
|
33 |
28 |
$0.00 |
| 1035F |
|
45 |
40 |
$0.00 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
12 |
12 |
$0.00 |
| 90743 |
|
13 |
13 |
$0.00 |
| 1159F |
|
16,890 |
15,559 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
42 |
40 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
486 |
463 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
983 |
971 |
$0.00 |
| 90715 |
|
213 |
212 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
38 |
38 |
$0.00 |
| 1160F |
|
18,774 |
17,299 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
941 |
903 |
$0.00 |
| 90648 |
|
212 |
211 |
$0.00 |
| 83655 |
|
85 |
85 |
$0.00 |
| 92552 |
|
1,113 |
1,102 |
$0.00 |
| 97803 |
|
139 |
130 |
$0.00 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
323 |
321 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
325 |
251 |
$0.00 |
| 90670 |
|
190 |
190 |
$0.00 |
| 90633 |
|
228 |
228 |
$0.00 |
| D0270 |
|
162 |
150 |
$0.00 |
| 81025 |
|
143 |
136 |
$0.00 |
| 90713 |
|
30 |
30 |
$0.00 |
| 90734 |
|
208 |
208 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
15 |
$0.00 |
| 91300 |
|
17 |
15 |
$0.00 |
| 90649 |
|
12 |
12 |
$0.00 |