| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
64,677 |
40,607 |
$5.71M |
| H2020 |
Therapeutic behavioral services, per diem |
15,108 |
9,616 |
$1.60M |
| D0999 |
Unspecified diagnostic procedure, by report |
16,985 |
11,141 |
$1.27M |
| D7140 |
Extraction, erupted tooth or exposed root |
3,060 |
1,038 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,751 |
2,474 |
$9K |
| D0330 |
Panoramic radiographic image |
2,343 |
1,463 |
$8K |
| D1110 |
Prophylaxis - adult |
2,709 |
1,866 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
1,752 |
1,128 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
3,904 |
2,628 |
$4K |
| D0274 |
Bitewings - four radiographic images |
3,721 |
2,291 |
$4K |
| 99051 |
|
1,451 |
868 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
168 |
93 |
$968.74 |
| D0220 |
Intraoral - periapical first radiographic image |
2,406 |
1,508 |
$734.37 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20,665 |
14,588 |
$581.36 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30,663 |
23,009 |
$400.96 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
27 |
$149.49 |
| D1999 |
|
41 |
41 |
$140.90 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
33 |
$129.58 |
| 0004A |
|
110 |
61 |
$111.24 |
| 90791 |
Psychiatric diagnostic evaluation |
874 |
586 |
$102.85 |
| 0012A |
|
415 |
264 |
$53.56 |
| 0011A |
|
427 |
274 |
$47.76 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
3,681 |
2,905 |
$42.19 |
| 0064A |
|
158 |
66 |
$37.08 |
| 97802 |
|
407 |
314 |
$24.09 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,900 |
4,939 |
$23.19 |
| 82962 |
|
9,744 |
6,862 |
$13.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
28 |
$10.18 |
| 36415 |
Collection of venous blood by venipuncture |
7,968 |
4,253 |
$7.74 |
| 82948 |
|
589 |
420 |
$7.59 |
| 85018 |
|
3,222 |
2,199 |
$2.36 |
| 81003 |
|
4,983 |
2,323 |
$1.79 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,000 |
3,110 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
5,955 |
4,046 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,486 |
923 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
452 |
365 |
$0.00 |
| 90685 |
|
663 |
356 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
868 |
719 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
366 |
268 |
$0.00 |
| 99173 |
|
1,939 |
1,336 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,778 |
1,296 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,167 |
1,558 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,453 |
1,970 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
224 |
155 |
$0.00 |
| 90734 |
|
13 |
13 |
$0.00 |
| D0270 |
|
826 |
530 |
$0.00 |
| 82274 |
|
1,282 |
438 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
218 |
168 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
123 |
104 |
$0.00 |
| 82947 |
|
741 |
633 |
$0.00 |
| 90670 |
|
128 |
95 |
$0.00 |
| 11721 |
|
539 |
414 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
149 |
115 |
$0.00 |
| 81025 |
|
13 |
12 |
$0.00 |
| 0003A |
|
71 |
71 |
$0.00 |
| 90661 |
|
69 |
48 |
$0.00 |
| 90658 |
|
135 |
88 |
$0.00 |
| 87275 |
|
57 |
35 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
13 |
$0.00 |
| 90863 |
|
813 |
525 |
$0.00 |
| 90633 |
|
16 |
12 |
$0.00 |
| 91300 |
|
53 |
13 |
$0.00 |
| 11720 |
|
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
95 |
66 |
$0.00 |
| 90710 |
|
16 |
14 |
$0.00 |
| 11056 |
|
41 |
33 |
$0.00 |
| 0002A |
|
229 |
182 |
$0.00 |
| 94060 |
|
42 |
32 |
$0.00 |
| 90715 |
|
16 |
15 |
$0.00 |
| 0013A |
|
47 |
47 |
$0.00 |
| 99201 |
|
14 |
14 |
$0.00 |
| 86769 |
|
51 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,336 |
3,116 |
$0.00 |
| 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 |
7,120 |
5,326 |
$0.00 |
| 90686 |
|
335 |
266 |
$0.00 |
| D0601 |
|
92 |
32 |
$0.00 |
| D0001 |
|
150 |
105 |
$0.00 |
| 92551 |
|
1,600 |
1,274 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,941 |
1,874 |
$0.00 |
| 4000F |
|
159 |
104 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,158 |
266 |
$0.00 |
| 87807 |
|
715 |
439 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
151 |
113 |
$0.00 |
| 0001A |
|
334 |
221 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
160 |
121 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,226 |
785 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,716 |
1,784 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,285 |
1,011 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
317 |
258 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
52 |
29 |
$0.00 |
| 90688 |
|
348 |
256 |
$0.00 |
| D1330 |
|
1,363 |
765 |
$0.00 |
| 0031A |
|
104 |
81 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
563 |
386 |
$0.00 |
| 1000F |
|
17 |
14 |
$0.00 |
| D0603 |
|
1,418 |
842 |
$0.00 |
| 91301 |
|
89 |
28 |
$0.00 |
| D1310 |
|
844 |
484 |
$0.00 |
| 90651 |
|
31 |
24 |
$0.00 |
| D0602 |
|
128 |
50 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
58 |
50 |
$0.00 |
| 87276 |
|
57 |
35 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
17 |
15 |
$0.00 |
| 90674 |
|
59 |
36 |
$0.00 |
| D4355 |
|
23 |
13 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
47 |
24 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
28 |
12 |
$0.00 |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
14 |
13 |
$0.00 |