| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
252,073 |
199,821 |
$33.52M |
| G9012 |
Other specified case management service not elsewhere classified |
4,936 |
2,499 |
$352K |
| 00003 |
Internal/system code - not a standard HCPCS code |
1,271 |
1,017 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,905 |
5,302 |
$168K |
| D1110 |
Prophylaxis - adult |
11,403 |
11,273 |
$164K |
| D1120 |
Prophylaxis - child |
5,371 |
5,343 |
$146K |
| 97810 |
|
7,722 |
4,201 |
$142K |
| D1206 |
Topical application of fluoride varnish |
13,511 |
13,448 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,589 |
3,824 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
8,835 |
8,747 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,663 |
9,573 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
12,523 |
12,345 |
$81K |
| G9008 |
Coordinated care fee, physician coordinated care oversight services |
502 |
281 |
$78K |
| 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 |
939 |
795 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,872 |
11,185 |
$58K |
| D9999 |
Unspecified adjunctive procedure, by report |
554 |
519 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
16,917 |
15,452 |
$51K |
| D0274 |
Bitewings - four radiographic images |
9,377 |
9,262 |
$47K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,564 |
2,276 |
$37K |
| D9430 |
|
6,723 |
6,353 |
$36K |
| D1351 |
Sealant - per tooth |
1,201 |
375 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,955 |
4,842 |
$28K |
| D2740 |
Crown - porcelain/ceramic |
84 |
81 |
$18K |
| 98940 |
|
15,319 |
7,695 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
457 |
427 |
$16K |
| D4341 |
|
499 |
346 |
$9K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
4,503 |
3,047 |
$7K |
| 97813 |
|
523 |
271 |
$7K |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
5,321 |
2,736 |
$7K |
| 97026 |
|
1,434 |
890 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
2,674 |
2,341 |
$5K |
| 90791 |
Psychiatric diagnostic evaluation |
763 |
630 |
$5K |
| 0064A |
|
174 |
161 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
123 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
173,456 |
120,364 |
$4K |
| D0270 |
|
2,823 |
2,712 |
$4K |
| 90674 |
|
2,143 |
1,842 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
88 |
64 |
$2K |
| D2140 |
|
94 |
75 |
$1K |
| D0601 |
|
1,044 |
1,022 |
$1K |
| D0603 |
|
1,227 |
1,196 |
$1K |
| D2331 |
|
27 |
24 |
$1K |
| 90480 |
|
39 |
26 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
30,991 |
25,237 |
$978.55 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12,836 |
10,534 |
$789.07 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$720.00 |
| 0012A |
|
1,091 |
1,075 |
$718.67 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
10,474 |
8,200 |
$697.33 |
| 90686 |
|
3,340 |
2,747 |
$669.48 |
| 0071A |
|
54 |
54 |
$600.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,001 |
12,704 |
$521.17 |
| D0602 |
|
661 |
640 |
$514.45 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
34 |
$456.00 |
| 0011A |
|
1,278 |
1,151 |
$367.82 |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$325.00 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
100 |
86 |
$285.65 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
5,094 |
3,651 |
$280.02 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,951 |
1,945 |
$274.29 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$210.00 |
| 97802 |
|
3,798 |
2,981 |
$182.10 |
| D9110 |
|
15 |
13 |
$171.00 |
| H1000 |
Prenatal care, at-risk assessment |
159 |
158 |
$126.31 |
| 96156 |
|
111 |
85 |
$100.93 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
589 |
481 |
$90.64 |
| 86580 |
|
1,199 |
998 |
$81.38 |
| 90633 |
|
1,090 |
870 |
$72.00 |
| 99401 |
|
12,963 |
10,647 |
$63.30 |
| 59430 |
|
71 |
59 |
$60.48 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$60.00 |
| 99215 |
Prolong outpt/office vis |
425 |
256 |
$57.20 |
| 88147 |
|
5,264 |
3,896 |
$49.56 |
| 90715 |
|
578 |
438 |
$45.00 |
| 0013A |
|
105 |
105 |
$40.00 |
| 90746 |
|
127 |
86 |
$37.42 |
| 90723 |
|
560 |
465 |
$36.00 |
| 90647 |
|
436 |
352 |
$36.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
366 |
293 |
$34.69 |
| 92552 |
|
9,530 |
7,742 |
$33.66 |
| 90670 |
|
986 |
790 |
$31.50 |
| 81025 |
|
9,679 |
6,656 |
$27.94 |
| 97803 |
|
8,184 |
6,791 |
$26.11 |
| 90677 |
|
50 |
46 |
$18.00 |
| 90716 |
|
47 |
37 |
$9.00 |
| 90620 |
|
32 |
26 |
$9.00 |
| 90734 |
|
361 |
281 |
$9.00 |
| 85018 |
|
9,293 |
7,809 |
$6.21 |
| 81002 |
|
6,066 |
4,476 |
$1.63 |
| 3075F |
|
1,910 |
1,887 |
$0.00 |
| Z1038 |
|
213 |
180 |
$0.00 |
| 3080F |
|
3,760 |
3,621 |
$0.00 |
| 3074F |
|
2,785 |
2,728 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
287 |
263 |
$0.00 |
| 90619 |
|
60 |
60 |
$0.00 |
| 3079F |
|
3,396 |
3,318 |
$0.00 |
| 93000 |
|
1,490 |
1,158 |
$0.00 |
| 3044F |
|
979 |
976 |
$0.00 |
| Z1032 |
|
430 |
423 |
$0.00 |
| Z1034 |
|
4,409 |
2,958 |
$0.00 |
| 90744 |
|
73 |
55 |
$0.00 |
| 99384 |
|
294 |
216 |
$0.00 |
| 99383 |
|
436 |
324 |
$0.00 |
| 80100 |
|
77 |
73 |
$0.00 |
| Z6204 |
|
15 |
14 |
$0.00 |
| 90732 |
|
66 |
47 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
353 |
222 |
$0.00 |
| Z6406 |
|
27 |
26 |
$0.00 |
| 90696 |
|
74 |
54 |
$0.00 |
| 99385 |
|
69 |
40 |
$0.00 |
| 99381 |
|
13 |
13 |
$0.00 |
| 99386 |
|
24 |
14 |
$0.00 |
| 82947 |
|
1,805 |
1,541 |
$0.00 |
| 99173 |
|
12,470 |
10,085 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,147 |
951 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,231 |
972 |
$0.00 |
| 90710 |
|
589 |
460 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,638 |
1,375 |
$0.00 |
| 3078F |
|
4,416 |
4,290 |
$0.00 |
| 3046F |
|
176 |
174 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,741 |
1,589 |
$0.00 |
| 83037 |
|
3,052 |
2,547 |
$0.00 |
| 90649 |
|
1,041 |
848 |
$0.00 |
| 3077F |
|
6,995 |
6,691 |
$0.00 |
| 99201 |
|
36 |
29 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
509 |
406 |
$0.00 |
| 11104 |
|
22 |
15 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
139 |
139 |
$0.00 |
| 90713 |
|
89 |
73 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
180 |
156 |
$0.00 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
71 |
70 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
151 |
140 |
$0.00 |
| 90700 |
|
98 |
72 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
40 |
27 |
$0.00 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
338 |
209 |
$0.00 |
| Z6400 |
|
50 |
50 |
$0.00 |
| 11400 |
|
21 |
15 |
$0.00 |
| 99382 |
|
96 |
68 |
$0.00 |
| 90681 |
|
20 |
16 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
20 |
12 |
$0.00 |
| 59425 |
|
18 |
12 |
$0.00 |
| 90785 |
|
36 |
14 |
$0.00 |
| 3051F |
|
26 |
26 |
$0.00 |