| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
33,010 |
21,592 |
$3.73M |
| D0999 |
Unspecified diagnostic procedure, by report |
32,637 |
25,474 |
$3.54M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
2,940 |
1,368 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
8,987 |
8,801 |
$28K |
| D1120 |
Prophylaxis - child |
8,761 |
8,585 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,968 |
2,672 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
4,277 |
4,112 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,421 |
2,738 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,285 |
2,707 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
3,735 |
3,584 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,404 |
3,359 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
1,705 |
1,680 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,213 |
5,713 |
$5K |
| D0274 |
Bitewings - four radiographic images |
3,486 |
3,422 |
$5K |
| D1110 |
Prophylaxis - adult |
1,112 |
1,089 |
$4K |
| D0272 |
Bitewings - two radiographic images |
2,582 |
2,518 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
334 |
267 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,712 |
4,558 |
$3K |
| D2331 |
|
173 |
158 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,183 |
6,649 |
$2K |
| 96127 |
|
7,067 |
5,992 |
$1K |
| 90651 |
|
114 |
96 |
$826.05 |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,948 |
3,245 |
$809.80 |
| D1206 |
Topical application of fluoride varnish |
3,767 |
3,752 |
$688.40 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
486 |
438 |
$662.40 |
| D2332 |
|
72 |
63 |
$441.60 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
99 |
89 |
$423.96 |
| D1351 |
Sealant - per tooth |
1,116 |
607 |
$326.40 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
82 |
73 |
$295.68 |
| 90791 |
Psychiatric diagnostic evaluation |
372 |
281 |
$283.90 |
| 90734 |
|
87 |
73 |
$233.35 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
98 |
86 |
$177.70 |
| 90686 |
|
554 |
467 |
$159.78 |
| 90715 |
|
66 |
59 |
$130.94 |
| D2330 |
|
214 |
168 |
$104.36 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$103.04 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,229 |
2,902 |
$102.60 |
| D2335 |
|
46 |
43 |
$93.19 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,018 |
865 |
$58.91 |
| D0330 |
Panoramic radiographic image |
547 |
546 |
$43.58 |
| 90633 |
|
38 |
30 |
$39.29 |
| 90834 |
Psychotherapy, 45 minutes with patient |
302 |
199 |
$36.47 |
| 99406 |
|
1,183 |
1,012 |
$35.19 |
| D0230 |
Intraoral - periapical each additional radiographic image |
379 |
365 |
$4.48 |
| 36415 |
Collection of venous blood by venipuncture |
518 |
412 |
$0.00 |
| D0603 |
|
77 |
77 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,086 |
1,020 |
$0.00 |
| 99441 |
|
132 |
114 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
12 |
12 |
$0.00 |
| 99443 |
|
47 |
41 |
$0.00 |
| D0602 |
|
57 |
57 |
$0.00 |
| 90619 |
|
74 |
70 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
184 |
139 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 99384 |
|
20 |
12 |
$0.00 |
| 90656 |
|
81 |
57 |
$0.00 |
| 87807 |
|
15 |
15 |
$0.00 |
| 99383 |
|
18 |
14 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
454 |
366 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
331 |
299 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
216 |
209 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
71 |
63 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
100 |
82 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
38 |
28 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
216 |
204 |
$0.00 |
| 99442 |
|
96 |
78 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
20 |
12 |
$0.00 |
| D4341 |
|
19 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
48 |
47 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
12 |
12 |
$0.00 |
| 90685 |
|
16 |
12 |
$0.00 |