| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
20,037 |
14,640 |
$3.06M |
| D7140 |
Extraction, erupted tooth or exposed root |
734 |
387 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,322 |
1,227 |
$59K |
| D1110 |
Prophylaxis - adult |
538 |
511 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,104 |
1,034 |
$20K |
| 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 |
2,283 |
1,616 |
$18K |
| D1120 |
Prophylaxis - child |
592 |
550 |
$15K |
| D1351 |
Sealant - per tooth |
414 |
118 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
221 |
212 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
830 |
769 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
104 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,260 |
3,553 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,282 |
2,083 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,314 |
1,512 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
25 |
$2K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
177 |
112 |
$1K |
| 3074F |
|
639 |
564 |
$1K |
| 3078F |
|
613 |
541 |
$1K |
| 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 |
113 |
82 |
$595.05 |
| 80305 |
|
114 |
81 |
$564.13 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
210 |
185 |
$257.81 |
| 90686 |
|
189 |
160 |
$243.32 |
| 3079F |
|
55 |
51 |
$200.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,504 |
4,510 |
$183.33 |
| 36415 |
Collection of venous blood by venipuncture |
469 |
438 |
$47.70 |
| 92551 |
|
60 |
59 |
$47.08 |
| 3075F |
|
15 |
15 |
$40.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27 |
27 |
$31.92 |
| D0190 |
|
565 |
529 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
139 |
119 |
$0.00 |
| 99177 |
|
20 |
20 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$0.00 |
| 3077F |
|
17 |
15 |
$0.00 |
| D1353 |
|
69 |
27 |
$0.00 |
| D0602 |
|
61 |
59 |
$0.00 |
| 36416 |
|
80 |
65 |
$0.00 |
| D1330 |
|
112 |
110 |
$0.00 |