| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
38,165 |
26,196 |
$4.61M |
| D0999 |
Unspecified diagnostic procedure, by report |
3,899 |
3,268 |
$442K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,585 |
985 |
$109K |
| 90651 |
|
1,123 |
923 |
$23K |
| 90734 |
|
839 |
650 |
$13K |
| 90670 |
|
1,979 |
1,383 |
$6K |
| 90620 |
|
396 |
337 |
$5K |
| 90710 |
|
210 |
143 |
$4K |
| D1120 |
Prophylaxis - child |
1,030 |
909 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
20 |
$2K |
| 90686 |
|
4,416 |
3,562 |
$2K |
| 90715 |
|
560 |
431 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,120 |
991 |
$2K |
| 90633 |
|
1,050 |
758 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,653 |
7,633 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,867 |
2,765 |
$1K |
| 90698 |
|
1,113 |
742 |
$1K |
| 90716 |
|
337 |
183 |
$1K |
| 90696 |
|
131 |
86 |
$765.61 |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
144 |
$720.44 |
| 90685 |
|
361 |
256 |
$658.11 |
| 90744 |
|
659 |
456 |
$629.77 |
| D0220 |
Intraoral - periapical first radiographic image |
521 |
457 |
$617.40 |
| 90707 |
|
300 |
157 |
$570.96 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,474 |
4,296 |
$552.50 |
| D0274 |
Bitewings - four radiographic images |
112 |
87 |
$485.16 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
227 |
$381.20 |
| 90680 |
|
791 |
528 |
$328.59 |
| D0140 |
Limited oral evaluation - problem focused |
140 |
122 |
$286.68 |
| D0230 |
Intraoral - periapical each additional radiographic image |
391 |
361 |
$275.70 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,959 |
1,422 |
$274.32 |
| D0272 |
Bitewings - two radiographic images |
63 |
56 |
$158.05 |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,777 |
2,221 |
$141.69 |
| 90700 |
|
152 |
78 |
$140.04 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,888 |
2,130 |
$110.02 |
| 96127 |
|
314 |
310 |
$43.80 |
| 81002 |
|
1,735 |
1,092 |
$7.80 |
| 99383 |
|
58 |
36 |
$0.00 |
| D1330 |
|
842 |
519 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
442 |
424 |
$0.00 |
| 0500F |
|
49 |
46 |
$0.00 |
| D1310 |
|
626 |
361 |
$0.00 |
| 90619 |
|
95 |
95 |
$0.00 |
| 99381 |
|
58 |
55 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
68 |
47 |
$0.00 |
| 90723 |
|
192 |
133 |
$0.00 |
| 90647 |
|
241 |
179 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
558 |
442 |
$0.00 |
| 90656 |
|
147 |
134 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
19 |
19 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
12 |
12 |
$0.00 |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
48 |
27 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,073 |
2,405 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,137 |
1,860 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,571 |
2,176 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
303 |
269 |
$0.00 |
| 0502F |
|
1,353 |
765 |
$0.00 |
| 99201 |
|
12 |
12 |
$0.00 |
| 90681 |
|
47 |
42 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
147 |
142 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
308 |
222 |
$0.00 |
| 99173 |
|
498 |
494 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
353 |
289 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
53 |
52 |
$0.00 |
| 81025 |
|
49 |
32 |
$0.00 |
| 90648 |
|
14 |
14 |
$0.00 |