| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,611 |
19,099 |
$1.61M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18,775 |
10,993 |
$598K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,974 |
1,158 |
$110K |
| D1110 |
Prophylaxis - adult |
6,001 |
3,256 |
$101K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,272 |
2,408 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,025 |
587 |
$67K |
| D0330 |
Panoramic radiographic image |
3,682 |
1,859 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
3,268 |
1,569 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
3,075 |
1,653 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,857 |
1,397 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
1,615 |
904 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
520 |
267 |
$26K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,873 |
1,340 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,900 |
1,018 |
$14K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
223 |
122 |
$10K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
204 |
99 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
79 |
$7K |
| 90837 |
Psychotherapy, 53 minutes with patient |
116 |
45 |
$4K |
| 90686 |
|
196 |
122 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
179 |
90 |
$2K |
| 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 |
170 |
141 |
$2K |
| 91320 |
|
14 |
13 |
$2K |
| 90750 |
|
17 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
796 |
373 |
$2K |
| 99205 |
Prolong outpt/office vis |
21 |
13 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
51 |
25 |
$1K |
| 90656 |
|
30 |
29 |
$491.50 |
| 90480 |
|
14 |
13 |
$479.28 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
63 |
40 |
$468.08 |
| 87806 |
|
30 |
18 |
$393.28 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
31 |
28 |
$342.00 |
| 90674 |
|
23 |
17 |
$265.43 |
| 90658 |
|
34 |
26 |
$249.36 |
| 3008F |
|
11,665 |
7,207 |
$2.61 |
| 3079F |
|
2,228 |
1,680 |
$0.02 |
| 3074F |
|
6,670 |
5,179 |
$0.01 |
| 3080F |
|
231 |
166 |
$0.00 |
| 1036F |
|
1,824 |
1,316 |
$0.00 |
| 3075F |
|
137 |
106 |
$0.00 |
| 1034F |
|
599 |
436 |
$0.00 |
| D5999 |
|
30 |
26 |
$0.00 |
| 3078F |
|
3,884 |
2,899 |
$0.00 |
| 4004F |
|
41 |
28 |
$0.00 |
| 3077F |
|
60 |
40 |
$0.00 |