| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
34,733 |
25,747 |
$2.21M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,037 |
10,736 |
$477K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,364 |
8,643 |
$297K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
29 |
26 |
$33K |
| D0330 |
Panoramic radiographic image |
1,123 |
916 |
$20K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,513 |
848 |
$20K |
| D1110 |
Prophylaxis - adult |
1,277 |
994 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,566 |
1,257 |
$15K |
| 90837 |
Psychotherapy, 53 minutes with patient |
765 |
323 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
1,747 |
1,326 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
91 |
$11K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
455 |
294 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
296 |
188 |
$10K |
| 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 |
1,226 |
946 |
$9K |
| D1206 |
Topical application of fluoride varnish |
1,636 |
1,279 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
285 |
182 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
391 |
177 |
$7K |
| D1120 |
Prophylaxis - child |
1,087 |
832 |
$7K |
| D0274 |
Bitewings - four radiographic images |
656 |
534 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
48 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,702 |
1,142 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
94 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
340 |
236 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
604 |
357 |
$2K |
| 92551 |
|
579 |
376 |
$2K |
| 99406 |
|
594 |
389 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
293 |
$2K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
85 |
65 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
723 |
495 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
134 |
106 |
$925.20 |
| 87430 |
|
767 |
517 |
$898.90 |
| 99173 |
|
673 |
428 |
$897.22 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$567.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
42 |
39 |
$553.66 |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
21 |
13 |
$531.58 |
| 90674 |
|
87 |
57 |
$335.24 |
| 90715 |
|
25 |
15 |
$181.40 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$136.50 |
| 80305 |
|
24 |
13 |
$128.00 |
| 93000 |
|
37 |
25 |
$127.20 |
| 90756 |
|
25 |
16 |
$126.03 |
| 81002 |
|
110 |
78 |
$91.35 |
| 90686 |
|
141 |
85 |
$75.23 |
| 90661 |
|
12 |
12 |
$73.70 |
| 90734 |
|
40 |
27 |
$20.00 |
| 90651 |
|
59 |
39 |
$20.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$10.00 |
| 90648 |
|
136 |
122 |
$5.00 |
| 90656 |
|
130 |
109 |
$5.00 |
| 90688 |
|
232 |
131 |
$5.00 |
| 3079F |
|
4,962 |
2,886 |
$0.52 |
| 3074F |
|
13,808 |
7,881 |
$0.41 |
| 3077F |
|
1,541 |
887 |
$0.27 |
| 3078F |
|
11,820 |
6,792 |
$0.24 |
| 3075F |
|
1,324 |
769 |
$0.13 |
| 3080F |
|
396 |
234 |
$0.01 |
| 99408 |
|
33 |
27 |
$0.00 |
| 3725F |
|
2,673 |
1,559 |
$0.00 |
| 90670 |
|
145 |
124 |
$0.00 |
| 4004F |
|
3,563 |
1,980 |
$0.00 |
| 90633 |
|
80 |
53 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
49 |
48 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
45 |
38 |
$0.00 |
| 90655 |
|
12 |
12 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
18 |
14 |
$0.00 |
| 90669 |
|
18 |
12 |
$0.00 |
| 90710 |
|
24 |
12 |
$0.00 |
| 3008F |
|
21,077 |
11,770 |
$0.00 |
| 1036F |
|
7,573 |
4,217 |
$0.00 |
| 90680 |
|
31 |
25 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
78 |
70 |
$0.00 |
| 90733 |
|
19 |
12 |
$0.00 |
| 90723 |
|
41 |
38 |
$0.00 |