| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,945 |
3,405 |
$731K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34,717 |
32,325 |
$530K |
| D0120 |
Periodic oral evaluation - established patient |
1,318 |
1,204 |
$175K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,259 |
2,208 |
$39K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,662 |
3,541 |
$38K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
898 |
887 |
$33K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,837 |
1,828 |
$20K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
514 |
501 |
$18K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
484 |
481 |
$17K |
| 0012A |
|
311 |
310 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
819 |
810 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
272 |
258 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
1,388 |
1,373 |
$10K |
| 0011A |
|
333 |
333 |
$9K |
| 90677 |
|
39 |
37 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
186 |
182 |
$7K |
| D1110 |
Prophylaxis - adult |
360 |
356 |
$6K |
| D0330 |
Panoramic radiographic image |
976 |
966 |
$6K |
| 90619 |
|
49 |
46 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
201 |
201 |
$6K |
| D1120 |
Prophylaxis - child |
280 |
279 |
$5K |
| 90686 |
|
1,119 |
1,092 |
$5K |
| 0064A |
|
128 |
128 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
112 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
299 |
290 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
62 |
$3K |
| 90651 |
|
164 |
161 |
$3K |
| 0072A |
|
85 |
85 |
$3K |
| 0071A |
|
83 |
83 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
486 |
484 |
$2K |
| 0002A |
|
52 |
51 |
$2K |
| 0004A |
|
53 |
53 |
$2K |
| D0274 |
Bitewings - four radiographic images |
392 |
389 |
$2K |
| 0001A |
|
47 |
46 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
109 |
105 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
552 |
534 |
$1K |
| 90697 |
|
14 |
12 |
$1K |
| 90670 |
|
125 |
119 |
$1K |
| D1206 |
Topical application of fluoride varnish |
141 |
141 |
$1K |
| 0124A |
|
23 |
22 |
$720.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
457 |
376 |
$648.00 |
| 0134A |
|
18 |
17 |
$568.77 |
| 90791 |
Psychiatric diagnostic evaluation |
44 |
43 |
$492.36 |
| 0003A |
|
12 |
12 |
$484.21 |
| 90461 |
|
42 |
41 |
$448.00 |
| 90656 |
|
146 |
145 |
$445.34 |
| 99173 |
|
1,288 |
1,267 |
$416.96 |
| 90480 |
|
16 |
16 |
$400.00 |
| 82947 |
|
981 |
940 |
$367.00 |
| 93000 |
|
38 |
38 |
$322.74 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
344 |
342 |
$292.04 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
35 |
$280.00 |
| 90474 |
|
25 |
25 |
$254.74 |
| D2940 |
|
27 |
25 |
$250.00 |
| 81000 |
|
547 |
538 |
$249.27 |
| 92551 |
|
131 |
131 |
$236.00 |
| D0180 |
|
12 |
12 |
$220.00 |
| 90715 |
|
35 |
34 |
$143.00 |
| 90734 |
|
42 |
42 |
$135.91 |
| D0272 |
Bitewings - two radiographic images |
30 |
29 |
$130.00 |
| 3078F |
|
10,861 |
10,047 |
$78.00 |
| 90633 |
|
85 |
82 |
$72.00 |
| 3074F |
|
11,075 |
10,253 |
$71.00 |
| 3075F |
|
2,319 |
2,236 |
$28.00 |
| 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 |
128 |
118 |
$27.60 |
| 3079F |
|
3,057 |
2,931 |
$26.00 |
| 3077F |
|
2,740 |
2,592 |
$21.00 |
| 91301 |
|
637 |
629 |
$19.00 |
| 3080F |
|
2,119 |
2,022 |
$16.00 |
| 94760 |
|
399 |
381 |
$12.92 |
| 91300 |
|
222 |
214 |
$7.00 |
| 91307 |
|
209 |
196 |
$3.00 |
| 85018 |
|
14 |
14 |
$1.00 |
| 87806 |
|
177 |
177 |
$0.00 |
| 82274 |
|
190 |
190 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
104 |
84 |
$0.00 |
| D1999 |
|
167 |
147 |
$0.00 |
| 91312 |
|
21 |
20 |
$0.00 |
| D5986 |
|
15 |
15 |
$0.00 |
| 91313 |
|
18 |
17 |
$0.00 |
| 1127F |
|
73 |
73 |
$0.00 |
| 91306 |
|
114 |
114 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
79 |
53 |
$0.00 |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
12 |
12 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
32 |
32 |
$0.00 |
| 91305 |
|
21 |
19 |
$0.00 |