| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,817 |
9,468 |
$1.57M |
| D0999 |
Unspecified diagnostic procedure, by report |
3,640 |
3,205 |
$466K |
| H2020 |
Therapeutic behavioral services, per diem |
2,654 |
1,781 |
$311K |
| D0330 |
Panoramic radiographic image |
947 |
887 |
$748.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
589 |
$116.52 |
| D0274 |
Bitewings - four radiographic images |
464 |
453 |
$83.64 |
| 3079F |
|
122 |
108 |
$25.00 |
| 3074F |
|
124 |
108 |
$25.00 |
| 3077F |
|
81 |
66 |
$20.00 |
| 3078F |
|
53 |
49 |
$15.00 |
| 3044F |
|
71 |
53 |
$10.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,435 |
2,020 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
454 |
372 |
$0.00 |
| 3725F |
|
272 |
223 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
75 |
62 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
529 |
357 |
$0.00 |
| 81025 |
|
866 |
681 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
189 |
147 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
26 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
313 |
258 |
$0.00 |
| 87210 |
|
230 |
174 |
$0.00 |
| 90756 |
|
79 |
61 |
$0.00 |
| 82947 |
|
48 |
40 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
74 |
73 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
57 |
50 |
$0.00 |
| 1160F |
|
74 |
65 |
$0.00 |
| 99173 |
|
69 |
56 |
$0.00 |
| 81002 |
|
82 |
64 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
36 |
13 |
$0.00 |
| 90658 |
|
29 |
29 |
$0.00 |
| 90715 |
|
20 |
19 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,173 |
4,095 |
$0.00 |
| 81000 |
|
446 |
316 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,039 |
780 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
764 |
671 |
$0.00 |
| 3008F |
|
2,088 |
1,746 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
542 |
389 |
$0.00 |
| 92551 |
|
32 |
27 |
$0.00 |
| 85018 |
|
215 |
140 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
393 |
318 |
$0.00 |
| 1036F |
|
23 |
23 |
$0.00 |
| 1126F |
|
42 |
37 |
$0.00 |
| 90686 |
|
70 |
66 |
$0.00 |
| 36416 |
|
14 |
13 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
42 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
65 |
53 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
197 |
160 |
$0.00 |
| 3080F |
|
18 |
13 |
$0.00 |
| 91301 |
|
73 |
53 |
$0.00 |
| 90674 |
|
15 |
15 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
27 |
12 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
29 |
23 |
$0.00 |
| 0012A |
|
13 |
12 |
$0.00 |