| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
86,449 |
62,730 |
$12.14M |
| D0999 |
Unspecified diagnostic procedure, by report |
10,832 |
8,438 |
$1.06M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
2,273 |
1,623 |
$154K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30,157 |
25,127 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
3,537 |
3,278 |
$6K |
| D0274 |
Bitewings - four radiographic images |
2,369 |
2,225 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,478 |
3,077 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,010 |
1,922 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
17,226 |
14,219 |
$3K |
| D1120 |
Prophylaxis - child |
2,246 |
2,124 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
1,751 |
1,545 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,710 |
4,264 |
$1K |
| D0272 |
Bitewings - two radiographic images |
479 |
443 |
$1K |
| 0502F |
|
2,964 |
1,759 |
$1K |
| D1110 |
Prophylaxis - adult |
411 |
341 |
$938.11 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,385 |
3,093 |
$922.08 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,419 |
3,079 |
$844.44 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
286 |
$837.84 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,084 |
756 |
$797.49 |
| D4341 |
|
83 |
38 |
$732.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,437 |
1,317 |
$721.68 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,403 |
2,092 |
$632.86 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,767 |
1,567 |
$513.57 |
| D1206 |
Topical application of fluoride varnish |
2,397 |
2,268 |
$444.19 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,294 |
2,155 |
$318.16 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
646 |
467 |
$192.84 |
| 0500F |
|
105 |
86 |
$176.40 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
301 |
274 |
$99.20 |
| 90834 |
Psychotherapy, 45 minutes with patient |
4,510 |
2,848 |
$94.40 |
| 90670 |
|
1,824 |
1,670 |
$91.02 |
| 99173 |
|
2,083 |
1,870 |
$89.40 |
| D9996 |
|
41 |
35 |
$75.00 |
| 81025 |
|
8,635 |
7,702 |
$50.02 |
| 90633 |
|
1,376 |
1,294 |
$42.31 |
| 90716 |
|
156 |
145 |
$35.91 |
| 90710 |
|
767 |
685 |
$33.11 |
| 90698 |
|
608 |
558 |
$32.00 |
| 90658 |
|
115 |
113 |
$21.41 |
| 90707 |
|
163 |
150 |
$19.20 |
| 90648 |
|
392 |
359 |
$16.71 |
| 90734 |
|
901 |
828 |
$12.80 |
| 90680 |
|
572 |
523 |
$12.80 |
| 90696 |
|
271 |
242 |
$12.80 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
745 |
576 |
$11.90 |
| 81000 |
|
8,628 |
7,634 |
$8.24 |
| 90715 |
|
537 |
469 |
$6.40 |
| 90688 |
|
218 |
199 |
$6.40 |
| 90651 |
|
451 |
423 |
$6.40 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
907 |
621 |
$0.00 |
| 90746 |
|
85 |
81 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,154 |
1,099 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,245 |
2,793 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,583 |
1,523 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
75 |
73 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,165 |
1,045 |
$0.00 |
| 99382 |
|
269 |
256 |
$0.00 |
| 90713 |
|
292 |
280 |
$0.00 |
| 80061 |
Lipid panel |
58 |
58 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
77 |
$0.00 |
| 90700 |
|
355 |
345 |
$0.00 |
| 90461 |
|
358 |
228 |
$0.00 |
| 90649 |
|
188 |
182 |
$0.00 |
| D0180 |
|
38 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
33 |
29 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
932 |
914 |
$0.00 |
| 96127 |
|
421 |
381 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
60 |
55 |
$0.00 |
| 99385 |
|
838 |
813 |
$0.00 |
| 99386 |
|
294 |
285 |
$0.00 |
| 99383 |
|
851 |
830 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
180 |
123 |
$0.00 |
| 90686 |
|
232 |
217 |
$0.00 |
| 90647 |
|
116 |
111 |
$0.00 |
| 90723 |
|
402 |
372 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
465 |
392 |
$0.00 |
| 99384 |
|
518 |
502 |
$0.00 |
| 99381 |
|
59 |
56 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
211 |
211 |
$0.00 |
| 90697 |
|
130 |
130 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
40 |
33 |
$0.00 |
| 87430 |
|
51 |
50 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
173 |
170 |
$0.00 |
| 90620 |
|
12 |
12 |
$0.00 |