| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
61,757 |
50,734 |
$4.05M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
46,833 |
26,425 |
$966K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,449 |
9,811 |
$502K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21,719 |
9,546 |
$268K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,303 |
3,162 |
$162K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,798 |
2,811 |
$142K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,811 |
2,289 |
$129K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,099 |
2,850 |
$128K |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,218 |
2,603 |
$110K |
| D0330 |
Panoramic radiographic image |
2,858 |
2,012 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,600 |
3,039 |
$75K |
| D1120 |
Prophylaxis - child |
5,266 |
3,538 |
$66K |
| D1206 |
Topical application of fluoride varnish |
6,028 |
4,075 |
$59K |
| D1110 |
Prophylaxis - adult |
1,916 |
1,242 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
3,859 |
2,525 |
$43K |
| 92551 |
|
10,165 |
6,151 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,507 |
1,807 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
777 |
494 |
$19K |
| 99381 |
|
480 |
273 |
$13K |
| 99384 |
|
313 |
169 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
809 |
459 |
$11K |
| 0002A |
|
459 |
249 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
743 |
437 |
$10K |
| 0001A |
|
401 |
231 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,795 |
1,251 |
$9K |
| 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 |
977 |
866 |
$8K |
| 0012A |
|
419 |
243 |
$8K |
| 0011A |
|
451 |
256 |
$8K |
| 99383 |
|
192 |
127 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,015 |
1,264 |
$7K |
| 99385 |
|
192 |
96 |
$6K |
| 90837 |
Psychotherapy, 53 minutes with patient |
145 |
57 |
$6K |
| 0013A |
|
204 |
106 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
196 |
110 |
$5K |
| D1354 |
|
655 |
151 |
$4K |
| D2140 |
|
194 |
83 |
$4K |
| 85018 |
|
3,651 |
2,184 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
112 |
62 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
99 |
$3K |
| 0072A |
|
134 |
71 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
80 |
42 |
$2K |
| 0071A |
|
112 |
62 |
$2K |
| 81002 |
|
1,617 |
935 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
215 |
128 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
291 |
267 |
$1K |
| D1351 |
Sealant - per tooth |
58 |
15 |
$946.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
80 |
47 |
$903.19 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
16 |
$894.20 |
| 81025 |
|
300 |
180 |
$869.08 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
25 |
14 |
$797.03 |
| 90651 |
|
2,320 |
1,524 |
$732.96 |
| 90670 |
|
3,695 |
2,285 |
$729.98 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
13 |
$634.59 |
| 90674 |
|
73 |
42 |
$603.85 |
| 99188 |
|
48 |
24 |
$563.03 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
87 |
50 |
$543.24 |
| 0003A |
|
24 |
13 |
$536.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
67 |
$488.71 |
| 17250 |
|
20 |
12 |
$485.92 |
| 90734 |
|
1,984 |
1,293 |
$355.74 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
51 |
24 |
$324.52 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
86 |
58 |
$291.92 |
| 90715 |
|
890 |
572 |
$254.68 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
51 |
37 |
$186.34 |
| 96127 |
|
81 |
76 |
$178.29 |
| 90620 |
|
447 |
276 |
$171.52 |
| 90686 |
|
3,001 |
1,893 |
$157.01 |
| 90656 |
|
69 |
65 |
$134.10 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
26 |
12 |
$97.50 |
| 90633 |
|
1,957 |
1,281 |
$74.22 |
| 90647 |
|
2,111 |
1,353 |
$56.79 |
| 1111F |
|
11,660 |
6,326 |
$50.00 |
| 3074F |
|
29,103 |
16,284 |
$34.37 |
| 90723 |
|
2,560 |
1,598 |
$33.46 |
| 90681 |
|
869 |
504 |
$25.88 |
| 81003 |
|
36 |
26 |
$23.46 |
| 90710 |
|
351 |
216 |
$16.47 |
| 99173 |
|
2,056 |
1,893 |
$9.60 |
| 90696 |
|
246 |
157 |
$5.56 |
| 91301 |
|
1,259 |
682 |
$5.55 |
| 91300 |
|
955 |
480 |
$4.29 |
| 91307 |
|
286 |
146 |
$1.33 |
| 90707 |
|
110 |
88 |
$0.43 |
| 90716 |
|
146 |
117 |
$0.37 |
| 91305 |
|
27 |
14 |
$0.16 |
| 90700 |
|
60 |
37 |
$0.02 |
| 90648 |
|
49 |
38 |
$0.01 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
21,906 |
11,610 |
$0.00 |
| 3078F |
|
25,274 |
14,179 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
2,136 |
1,144 |
$0.00 |
| 3077F |
|
2,890 |
1,591 |
$0.00 |
| 4004F |
|
1,159 |
621 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
170 |
107 |
$0.00 |
| 0502F |
|
17 |
13 |
$0.00 |
| 90671 |
|
89 |
47 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
29 |
17 |
$0.00 |
| 2001F |
|
40,456 |
22,542 |
$0.00 |
| 3075F |
|
3,930 |
2,182 |
$0.00 |
| 3080F |
|
1,326 |
717 |
$0.00 |
| 3008F |
|
40,394 |
22,543 |
$0.00 |
| 1036F |
|
24,434 |
13,483 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
22,530 |
11,979 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
666 |
375 |
$0.00 |
| 1034F |
|
2,938 |
1,547 |
$0.00 |
| 3079F |
|
8,901 |
5,005 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
269 |
234 |
$0.00 |
| 1035F |
|
1,423 |
757 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
1,393 |
724 |
$0.00 |
| 90697 |
|
535 |
286 |
$0.00 |
| 90677 |
|
198 |
191 |
$0.00 |
| 99172 |
|
373 |
369 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
244 |
133 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
30 |
14 |
$0.00 |