| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
20,119 |
13,018 |
$3.74M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
41,351 |
33,948 |
$534K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18,907 |
17,333 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
5,602 |
5,396 |
$208K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
8,303 |
6,459 |
$155K |
| 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 |
1,405 |
667 |
$89K |
| 97803 |
|
3,997 |
3,877 |
$83K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,068 |
1,933 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,526 |
2,509 |
$49K |
| D1110 |
Prophylaxis - adult |
3,004 |
2,986 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,706 |
1,509 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
1,652 |
1,646 |
$39K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,408 |
1,318 |
$37K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,291 |
1,177 |
$36K |
| 90461 |
|
2,408 |
1,969 |
$35K |
| 97802 |
|
936 |
914 |
$35K |
| 99215 |
Prolong outpt/office vis |
2,073 |
1,939 |
$33K |
| H0038 |
Self-help/peer services, per 15 minutes |
692 |
326 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
2,318 |
2,267 |
$26K |
| D1120 |
Prophylaxis - child |
1,484 |
1,475 |
$20K |
| D0330 |
Panoramic radiographic image |
2,316 |
2,306 |
$20K |
| 0011A |
|
522 |
516 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,337 |
1,329 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
499 |
422 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
5,671 |
5,564 |
$16K |
| 0012A |
|
406 |
404 |
$15K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
522 |
492 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
459 |
347 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
296 |
293 |
$14K |
| 90677 |
|
272 |
211 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,331 |
3,298 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,504 |
1,489 |
$9K |
| 98940 |
|
1,371 |
841 |
$6K |
| D9995 |
|
504 |
498 |
$6K |
| D0191 |
|
449 |
444 |
$5K |
| 11721 |
|
339 |
333 |
$5K |
| 90697 |
|
106 |
77 |
$5K |
| 90651 |
|
292 |
235 |
$4K |
| 0064A |
|
119 |
118 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
232 |
232 |
$4K |
| 90686 |
|
2,124 |
1,721 |
$4K |
| 11720 |
|
518 |
518 |
$3K |
| 90619 |
|
30 |
24 |
$3K |
| D0180 |
|
190 |
190 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
281 |
249 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
287 |
280 |
$2K |
| 0004A |
|
49 |
48 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
2,041 |
1,545 |
$2K |
| 99205 |
Prolong outpt/office vis |
50 |
50 |
$1K |
| 90670 |
|
469 |
436 |
$1K |
| 90656 |
|
519 |
516 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
45 |
40 |
$1K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
288 |
188 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
24 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
54 |
54 |
$903.16 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
33 |
33 |
$872.85 |
| 90715 |
|
55 |
52 |
$624.86 |
| 99386 |
|
12 |
12 |
$583.25 |
| 90633 |
|
616 |
505 |
$565.78 |
| D0270 |
|
216 |
216 |
$519.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
16 |
15 |
$498.67 |
| 90832 |
Psychotherapy, 30 minutes with patient |
11,897 |
7,372 |
$448.41 |
| 99381 |
|
13 |
13 |
$422.90 |
| 92551 |
|
166 |
165 |
$394.67 |
| 90658 |
|
183 |
179 |
$388.67 |
| 90685 |
|
24 |
24 |
$386.11 |
| 90716 |
|
187 |
153 |
$348.64 |
| D0170 |
|
77 |
76 |
$276.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$250.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$240.00 |
| 90688 |
|
126 |
123 |
$238.96 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,407 |
1,138 |
$230.27 |
| D1320 |
|
22 |
22 |
$220.00 |
| 96150 |
|
270 |
259 |
$184.07 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
25 |
25 |
$173.82 |
| 90630 |
|
24 |
24 |
$165.00 |
| 90723 |
|
15 |
15 |
$109.08 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$90.00 |
| 90707 |
|
32 |
25 |
$89.93 |
| 11056 |
|
41 |
40 |
$79.59 |
| 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 |
824 |
730 |
$60.67 |
| 96127 |
|
138 |
100 |
$52.08 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
1,352 |
628 |
$47.13 |
| 90647 |
|
91 |
90 |
$37.82 |
| 90655 |
|
12 |
12 |
$13.12 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$11.22 |
| 99173 |
|
23 |
23 |
$5.68 |
| T1016 |
Case management, each 15 minutes |
46 |
25 |
$4.50 |
| D1330 |
|
2,864 |
2,768 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,190 |
1,430 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
46 |
46 |
$0.00 |
| D5899 |
|
44 |
25 |
$0.00 |
| D1310 |
|
402 |
391 |
$0.00 |
| 99383 |
|
16 |
16 |
$0.00 |
| D1999 |
|
639 |
593 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
44 |
43 |
$0.00 |
| 99408 |
|
121 |
87 |
$0.00 |
| 90713 |
|
15 |
12 |
$0.00 |
| 86480 |
|
96 |
96 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 90681 |
|
25 |
13 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
16 |
13 |
$0.00 |