| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,764 |
20,915 |
$4.23M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,433 |
9,973 |
$139K |
| D9999 |
Unspecified adjunctive procedure, by report |
419 |
355 |
$85K |
| D0330 |
Panoramic radiographic image |
1,732 |
1,543 |
$56K |
| D1110 |
Prophylaxis - adult |
1,436 |
1,277 |
$50K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
1,214 |
1,155 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,163 |
1,901 |
$44K |
| D1120 |
Prophylaxis - child |
1,821 |
1,538 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,547 |
2,202 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,148 |
1,829 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,156 |
1,020 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
458 |
329 |
$24K |
| D0274 |
Bitewings - four radiographic images |
883 |
799 |
$20K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,941 |
3,795 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
280 |
136 |
$16K |
| D0999 |
Unspecified diagnostic procedure, by report |
631 |
528 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,199 |
1,901 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
185 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
424 |
396 |
$9K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,593 |
1,105 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,140 |
517 |
$6K |
| D0272 |
Bitewings - two radiographic images |
573 |
465 |
$6K |
| 90686 |
|
132 |
128 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
64 |
55 |
$734.41 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
2,143 |
1,743 |
$717.90 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
78 |
74 |
$519.98 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$485.16 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
30 |
14 |
$451.16 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,047 |
959 |
$295.13 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
14 |
12 |
$209.94 |
| 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 |
555 |
489 |
$65.03 |
| 3078F |
|
213 |
188 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
46 |
43 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
15 |
$0.00 |
| 3079F |
|
41 |
40 |
$0.00 |
| 3074F |
|
406 |
357 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
360 |
303 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
28 |
28 |
$0.00 |
| 3008F |
|
102 |
89 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
25 |
$0.00 |