| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
96,161 |
77,615 |
$13.06M |
| D0999 |
Unspecified diagnostic procedure, by report |
3,600 |
3,096 |
$377K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
38,901 |
33,908 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34,440 |
26,476 |
$5K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
5,746 |
4,604 |
$2K |
| 90686 |
|
1,172 |
907 |
$966.97 |
| Q3014 |
Telehealth originating site facility fee |
2,954 |
1,538 |
$425.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
246 |
201 |
$225.05 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
320 |
261 |
$76.84 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,944 |
1,526 |
$48.50 |
| 90734 |
|
25 |
14 |
$35.80 |
| 90715 |
|
39 |
28 |
$35.80 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
324 |
268 |
$32.16 |
| 90651 |
|
140 |
127 |
$23.00 |
| 81002 |
|
213 |
166 |
$2.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
25 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
60 |
53 |
$0.00 |
| D1120 |
Prophylaxis - child |
789 |
718 |
$0.00 |
| 90681 |
|
97 |
75 |
$0.00 |
| 99201 |
|
44 |
36 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
843 |
804 |
$0.00 |
| D1110 |
Prophylaxis - adult |
117 |
104 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
184 |
165 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
93 |
82 |
$0.00 |
| 90710 |
|
14 |
12 |
$0.00 |
| 90633 |
|
118 |
101 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
193 |
174 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
40 |
40 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
77 |
76 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
45 |
44 |
$0.00 |
| 90380 |
|
13 |
12 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| 90682 |
|
15 |
13 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
12 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
27 |
26 |
$0.00 |
| 90647 |
|
221 |
177 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
854 |
798 |
$0.00 |
| D1330 |
|
498 |
433 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
383 |
269 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
699 |
649 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
159 |
140 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
218 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
312 |
293 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
454 |
427 |
$0.00 |
| 96127 |
|
236 |
228 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
127 |
114 |
$0.00 |
| 82962 |
|
80 |
65 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
634 |
579 |
$0.00 |
| 90677 |
|
235 |
187 |
$0.00 |
| 90619 |
|
60 |
58 |
$0.00 |
| 90656 |
|
146 |
137 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
28 |
$0.00 |
| 99381 |
|
47 |
46 |
$0.00 |
| 90723 |
|
187 |
146 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
15 |
15 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
30 |
29 |
$0.00 |
| 90716 |
|
16 |
12 |
$0.00 |
| 90381 |
|
51 |
41 |
$0.00 |
| 90620 |
|
12 |
12 |
$0.00 |