| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
64,052 |
45,873 |
$9.16M |
| D0999 |
Unspecified diagnostic procedure, by report |
2,219 |
1,541 |
$217K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
2,972 |
1,673 |
$207K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
104 |
38 |
$9K |
| 90651 |
|
853 |
745 |
$7K |
| 90734 |
|
567 |
490 |
$5K |
| 0011A |
|
111 |
105 |
$4K |
| 0012A |
|
88 |
88 |
$4K |
| S5190 |
Wellness assessment, performed by non-physician |
885 |
793 |
$3K |
| 90688 |
|
972 |
811 |
$2K |
| 90715 |
|
855 |
774 |
$1K |
| 90686 |
|
1,011 |
899 |
$904.35 |
| 0001A |
|
18 |
18 |
$758.52 |
| 90670 |
|
472 |
385 |
$638.77 |
| 90723 |
|
330 |
275 |
$533.72 |
| D1120 |
Prophylaxis - child |
634 |
508 |
$533.00 |
| D0120 |
Periodic oral evaluation - established patient |
814 |
637 |
$532.00 |
| 0002A |
|
12 |
12 |
$505.68 |
| 90633 |
|
337 |
294 |
$496.72 |
| D1206 |
Topical application of fluoride varnish |
1,237 |
1,015 |
$416.00 |
| 99422 |
|
15 |
12 |
$407.10 |
| 90677 |
|
126 |
124 |
$334.20 |
| 90647 |
|
346 |
302 |
$275.97 |
| 90619 |
|
280 |
267 |
$267.36 |
| 90680 |
|
122 |
80 |
$178.58 |
| 96152 |
|
458 |
196 |
$168.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,713 |
17,869 |
$160.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15,036 |
12,493 |
$101.60 |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,803 |
3,435 |
$87.48 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
988 |
858 |
$64.62 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,668 |
1,380 |
$52.96 |
| 90710 |
|
168 |
155 |
$41.40 |
| 36415 |
Collection of venous blood by venipuncture |
5,251 |
4,749 |
$40.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
82 |
$30.85 |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
94 |
$28.00 |
| 90656 |
|
131 |
126 |
$16.71 |
| 90681 |
|
14 |
14 |
$16.71 |
| 90756 |
|
112 |
110 |
$16.71 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,927 |
1,674 |
$13.70 |
| 90685 |
|
18 |
13 |
$6.40 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
785 |
724 |
$5.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
828 |
708 |
$3.00 |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
237 |
175 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,706 |
1,559 |
$0.00 |
| 99000 |
|
172 |
155 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
460 |
398 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
25 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
168 |
158 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
28 |
$0.00 |
| D1330 |
|
418 |
321 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,110 |
1,066 |
$0.00 |
| 97802 |
|
132 |
126 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
234 |
233 |
$0.00 |
| 90696 |
|
42 |
38 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
12 |
$0.00 |
| 99383 |
|
74 |
70 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
29 |
24 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
50 |
$0.00 |
| 0500F |
|
24 |
24 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
46 |
41 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
34 |
27 |
$0.00 |
| 99384 |
|
36 |
35 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
840 |
784 |
$0.00 |
| 90461 |
|
1,652 |
1,412 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
689 |
643 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,179 |
1,971 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
901 |
744 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,910 |
1,710 |
$0.00 |
| 97803 |
|
1,084 |
1,040 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,403 |
1,261 |
$0.00 |
| 0502F |
|
894 |
629 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
432 |
394 |
$0.00 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
22 |
15 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
86 |
85 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
100 |
97 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
403 |
387 |
$0.00 |
| D1110 |
Prophylaxis - adult |
106 |
103 |
$0.00 |
| D0180 |
|
16 |
12 |
$0.00 |