| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
64,349 |
46,127 |
$8.93M |
| D0999 |
Unspecified diagnostic procedure, by report |
16,778 |
14,191 |
$1.88M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,089 |
760 |
$72K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,349 |
21,289 |
$3K |
| 0012A |
|
54 |
51 |
$2K |
| 0011A |
|
53 |
51 |
$1K |
| 90715 |
|
479 |
434 |
$1K |
| 90670 |
|
665 |
632 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,532 |
2,318 |
$903.76 |
| 90686 |
|
1,785 |
1,654 |
$870.72 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,689 |
2,332 |
$794.52 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,139 |
2,907 |
$768.40 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,572 |
4,197 |
$743.98 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,312 |
5,459 |
$731.98 |
| 90734 |
|
17 |
15 |
$564.05 |
| 0001A |
|
13 |
13 |
$547.82 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
6,093 |
5,643 |
$525.24 |
| 90633 |
|
528 |
506 |
$401.21 |
| 90698 |
|
342 |
327 |
$347.72 |
| 90688 |
|
142 |
126 |
$317.05 |
| D0120 |
Periodic oral evaluation - established patient |
5,163 |
4,904 |
$224.00 |
| D1110 |
Prophylaxis - adult |
1,935 |
1,802 |
$189.40 |
| D0210 |
Intraoral - complete series of radiographic images |
1,601 |
1,534 |
$133.40 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,687 |
1,346 |
$128.95 |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,265 |
2,844 |
$120.92 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,951 |
2,850 |
$105.25 |
| D1206 |
Topical application of fluoride varnish |
6,215 |
5,886 |
$104.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
117 |
105 |
$100.80 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,754 |
1,468 |
$96.30 |
| D1120 |
Prophylaxis - child |
4,408 |
4,245 |
$82.00 |
| D0274 |
Bitewings - four radiographic images |
3,376 |
3,174 |
$67.60 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,116 |
2,600 |
$56.30 |
| D0220 |
Intraoral - periapical first radiographic image |
5,159 |
4,765 |
$56.00 |
| 90744 |
|
90 |
88 |
$50.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,120 |
3,703 |
$49.40 |
| D0140 |
Limited oral evaluation - problem focused |
1,568 |
1,407 |
$48.60 |
| 90680 |
|
366 |
351 |
$45.88 |
| 0502F |
|
3,779 |
2,265 |
$44.10 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
985 |
919 |
$32.15 |
| 90685 |
|
59 |
42 |
$25.60 |
| 90651 |
|
275 |
268 |
$19.20 |
| 90696 |
|
66 |
66 |
$6.40 |
| 90710 |
|
246 |
241 |
$6.40 |
| 96127 |
|
4,925 |
4,354 |
$2.00 |
| 90791 |
Psychiatric diagnostic evaluation |
187 |
165 |
$1.00 |
| 3079F |
|
1,839 |
1,670 |
$0.00 |
| 3075F |
|
1,154 |
1,060 |
$0.00 |
| 1036F |
|
10,152 |
8,454 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
26 |
$0.00 |
| 3080F |
|
73 |
66 |
$0.00 |
| 1126F |
|
468 |
434 |
$0.00 |
| D0603 |
|
892 |
803 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
168 |
150 |
$0.00 |
| 90677 |
|
198 |
195 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,468 |
722 |
$0.00 |
| 90619 |
|
123 |
118 |
$0.00 |
| D0602 |
|
99 |
93 |
$0.00 |
| 3074F |
|
8,881 |
7,916 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
323 |
249 |
$0.00 |
| 3008F |
|
13,810 |
12,002 |
$0.00 |
| 0503F |
|
133 |
115 |
$0.00 |
| 90716 |
|
16 |
15 |
$0.00 |
| 1125F |
|
13 |
12 |
$0.00 |
| 99383 |
|
30 |
14 |
$0.00 |
| 90656 |
|
485 |
458 |
$0.00 |
| D9995 |
|
84 |
60 |
$0.00 |
| 99381 |
|
15 |
15 |
$0.00 |
| 90461 |
|
2,881 |
2,649 |
$0.00 |
| D0270 |
|
303 |
295 |
$0.00 |
| D4341 |
|
290 |
175 |
$0.00 |
| 3078F |
|
8,512 |
7,632 |
$0.00 |
| 3725F |
|
6,346 |
5,606 |
$0.00 |
| 3077F |
|
536 |
483 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,995 |
5,521 |
$0.00 |
| 1160F |
|
13,270 |
10,956 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
94 |
87 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
160 |
72 |
$0.00 |
| 90658 |
|
25 |
23 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
86 |
78 |
$0.00 |
| 90662 |
|
26 |
26 |
$0.00 |
| 90687 |
|
14 |
14 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
27 |
$0.00 |
| 90648 |
|
24 |
24 |
$0.00 |
| 90621 |
|
12 |
12 |
$0.00 |
| 90707 |
|
13 |
12 |
$0.00 |