| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
133,102 |
94,744 |
$17.74M |
| D0999 |
Unspecified diagnostic procedure, by report |
6,185 |
5,468 |
$724K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,541 |
1,151 |
$105K |
| 90651 |
|
3,184 |
2,536 |
$26K |
| 90734 |
|
2,098 |
1,572 |
$20K |
| 90710 |
|
1,683 |
1,171 |
$15K |
| 90620 |
|
1,610 |
1,353 |
$9K |
| 90670 |
|
8,092 |
5,745 |
$8K |
| H2000 |
Comprehensive multidisciplinary evaluation |
91 |
52 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
26,712 |
21,890 |
$7K |
| 90686 |
|
12,796 |
10,654 |
$5K |
| 90633 |
|
5,052 |
3,737 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15,595 |
13,583 |
$4K |
| 90696 |
|
1,513 |
1,034 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12,787 |
9,927 |
$4K |
| 90716 |
|
2,414 |
1,733 |
$4K |
| 90715 |
|
3,512 |
2,927 |
$3K |
| 90698 |
|
5,492 |
3,816 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
8,558 |
5,055 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
1,543 |
1,318 |
$2K |
| 0502F |
|
21,403 |
12,053 |
$2K |
| 90707 |
|
2,329 |
1,631 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13,567 |
11,054 |
$1K |
| 90685 |
|
927 |
704 |
$805.06 |
| 0500F |
|
2,295 |
2,142 |
$778.82 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
8,839 |
6,647 |
$717.74 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
3,002 |
2,660 |
$660.60 |
| 90723 |
|
2,484 |
1,983 |
$601.88 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
629 |
574 |
$595.00 |
| 90744 |
|
3,320 |
2,363 |
$513.72 |
| 90680 |
|
3,447 |
2,443 |
$513.47 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,116 |
4,377 |
$417.95 |
| 90656 |
|
984 |
903 |
$328.88 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,126 |
3,607 |
$321.50 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,671 |
6,642 |
$270.77 |
| 81002 |
|
22,587 |
14,604 |
$179.33 |
| 90700 |
|
1,063 |
827 |
$177.28 |
| 92227 |
|
77 |
38 |
$158.16 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
42 |
36 |
$146.16 |
| 96127 |
|
1,208 |
1,178 |
$146.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
236 |
200 |
$124.44 |
| 99381 |
|
1,954 |
1,748 |
$124.05 |
| 81025 |
|
3,762 |
2,979 |
$118.78 |
| 59430 |
|
56 |
33 |
$100.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
646 |
546 |
$78.50 |
| 90682 |
|
185 |
147 |
$54.00 |
| 90648 |
|
76 |
72 |
$44.90 |
| 99215 |
Prolong outpt/office vis |
148 |
129 |
$44.10 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,160 |
4,382 |
$32.36 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
867 |
581 |
$32.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
362 |
295 |
$29.43 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
78 |
73 |
$29.20 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
574 |
479 |
$15.65 |
| 82962 |
|
1,308 |
933 |
$8.40 |
| D0220 |
Intraoral - periapical first radiographic image |
1,828 |
1,765 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
237 |
216 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$0.00 |
| 90681 |
|
1,567 |
1,243 |
$0.00 |
| 99201 |
|
1,032 |
657 |
$0.00 |
| 91322 |
|
45 |
45 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,436 |
1,371 |
$0.00 |
| 90713 |
|
67 |
56 |
$0.00 |
| 91321 |
|
190 |
176 |
$0.00 |
| D1110 |
Prophylaxis - adult |
152 |
134 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
256 |
232 |
$0.00 |
| 87210 |
|
109 |
67 |
$0.00 |
| 59025 |
Fetal non-stress test |
76 |
57 |
$0.00 |
| A4267 |
Contraceptive supply, condom, male, each |
48 |
37 |
$0.00 |
| 99173 |
|
131 |
115 |
$0.00 |
| 90662 |
|
13 |
13 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
69 |
58 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
973 |
924 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
266 |
245 |
$0.00 |
| 0503F |
|
673 |
516 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
879 |
841 |
$0.00 |
| 90647 |
|
2,668 |
2,097 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
680 |
661 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
93 |
83 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
327 |
309 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
345 |
326 |
$0.00 |
| D1330 |
|
1,293 |
1,148 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
1,084 |
$0.00 |
| 90677 |
|
1,000 |
906 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
264 |
252 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,716 |
1,633 |
$0.00 |
| 90381 |
|
76 |
66 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
154 |
149 |
$0.00 |
| 93000 |
|
59 |
50 |
$0.00 |
| 99383 |
|
109 |
95 |
$0.00 |
| 99384 |
|
12 |
12 |
$0.00 |
| 96156 |
|
32 |
32 |
$0.00 |
| 90619 |
|
618 |
593 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
33 |
31 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
228 |
225 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
50 |
48 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
29 |
$0.00 |
| 58300 |
|
17 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
50 |
24 |
$0.00 |
| 99385 |
|
13 |
13 |
$0.00 |
| CGSMG |
|
21 |
21 |
$0.00 |