| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
65,588 |
53,821 |
$6.07M |
| D1110 |
Prophylaxis - adult |
6,742 |
6,595 |
$90K |
| D1120 |
Prophylaxis - child |
3,941 |
3,918 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
8,274 |
8,084 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,995 |
2,689 |
$65K |
| D1206 |
Topical application of fluoride varnish |
5,710 |
5,686 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
5,362 |
5,238 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,211 |
6,080 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,572 |
2,825 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,235 |
7,366 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
11,258 |
10,626 |
$44K |
| 00003 |
Internal/system code - not a standard HCPCS code |
340 |
279 |
$41K |
| D9999 |
Unspecified adjunctive procedure, by report |
409 |
395 |
$41K |
| 59425 |
|
2,024 |
1,420 |
$31K |
| D0274 |
Bitewings - four radiographic images |
5,924 |
5,798 |
$30K |
| D9430 |
|
5,838 |
5,496 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,383 |
4,245 |
$26K |
| D4341 |
|
1,434 |
850 |
$23K |
| 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 |
7,141 |
6,416 |
$19K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
1,455 |
986 |
$15K |
| D1351 |
Sealant - per tooth |
510 |
154 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
89,078 |
74,126 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
755 |
520 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
233 |
218 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
78 |
78 |
$5K |
| D0270 |
|
2,979 |
2,876 |
$4K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,768 |
1,957 |
$3K |
| 99215 |
Prolong outpt/office vis |
152 |
142 |
$3K |
| 98940 |
|
7,652 |
4,644 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,567 |
8,951 |
$1K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
60 |
38 |
$933.63 |
| D2331 |
|
33 |
28 |
$660.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
4,043 |
3,857 |
$646.77 |
| D0272 |
Bitewings - two radiographic images |
124 |
123 |
$605.00 |
| 59430 |
|
99 |
87 |
$544.32 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
9,818 |
8,888 |
$453.52 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$385.00 |
| 81025 |
|
3,878 |
3,162 |
$382.09 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
6,345 |
6,122 |
$354.40 |
| D0603 |
|
607 |
591 |
$309.00 |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
1,554 |
988 |
$300.79 |
| 90674 |
|
695 |
692 |
$254.76 |
| D0602 |
|
432 |
427 |
$237.00 |
| D0601 |
|
414 |
409 |
$193.00 |
| D2330 |
|
19 |
13 |
$165.00 |
| 99401 |
|
6,451 |
6,207 |
$132.53 |
| 92552 |
|
4,393 |
4,206 |
$119.75 |
| 99384 |
|
287 |
256 |
$79.54 |
| 97803 |
|
4,789 |
4,634 |
$78.07 |
| 99383 |
|
308 |
279 |
$54.59 |
| 81002 |
|
3,654 |
3,212 |
$50.66 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
753 |
714 |
$39.00 |
| 88147 |
|
1,297 |
1,256 |
$30.45 |
| 82947 |
|
2,412 |
2,218 |
$28.51 |
| 3077F |
|
3,035 |
2,732 |
$28.51 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
375 |
375 |
$27.95 |
| 90686 |
|
2,977 |
2,772 |
$18.00 |
| 85018 |
|
5,273 |
4,957 |
$10.35 |
| 99173 |
|
6,169 |
5,873 |
$6.83 |
| J3490 |
Unclassified drugs |
327 |
222 |
$0.01 |
| 93000 |
|
781 |
724 |
$0.00 |
| 3080F |
|
1,622 |
1,474 |
$0.00 |
| 3075F |
|
724 |
711 |
$0.00 |
| 90696 |
|
35 |
34 |
$0.00 |
| 90647 |
|
296 |
289 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
243 |
157 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
672 |
656 |
$0.00 |
| 90723 |
|
334 |
315 |
$0.00 |
| 86580 |
|
858 |
786 |
$0.00 |
| 3079F |
|
1,603 |
1,547 |
$0.00 |
| 3074F |
|
1,398 |
1,350 |
$0.00 |
| 90732 |
|
588 |
536 |
$0.00 |
| Z1038 |
|
128 |
112 |
$0.00 |
| 99386 |
|
62 |
62 |
$0.00 |
| 97802 |
|
874 |
817 |
$0.00 |
| Z1034 |
|
1,116 |
685 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,271 |
1,173 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
91 |
81 |
$0.00 |
| 3044F |
|
151 |
151 |
$0.00 |
| Z1032 |
|
125 |
118 |
$0.00 |
| 99406 |
|
24 |
15 |
$0.00 |
| 99385 |
|
154 |
153 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
201 |
196 |
$0.00 |
| 96156 |
|
75 |
58 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
18 |
15 |
$0.00 |
| 90716 |
|
24 |
21 |
$0.00 |
| 96150 |
|
22 |
12 |
$0.00 |
| 90620 |
|
148 |
127 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
13 |
13 |
$0.00 |
| 99462 |
|
17 |
12 |
$0.00 |
| 3078F |
|
2,007 |
1,912 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
583 |
537 |
$0.00 |
| 90633 |
|
575 |
544 |
$0.00 |
| 90710 |
|
364 |
346 |
$0.00 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
2,366 |
2,134 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
907 |
845 |
$0.00 |
| 90734 |
|
375 |
328 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
780 |
589 |
$0.00 |
| 83037 |
|
1,408 |
1,285 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
708 |
620 |
$0.00 |
| 90649 |
|
790 |
741 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,519 |
1,437 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
814 |
749 |
$0.00 |
| 90700 |
|
26 |
26 |
$0.00 |
| 90746 |
|
101 |
62 |
$0.00 |
| 90715 |
|
444 |
370 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
162 |
155 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
57 |
53 |
$0.00 |
| 97810 |
|
461 |
350 |
$0.00 |
| 99382 |
|
52 |
52 |
$0.00 |
| H1000 |
Prenatal care, at-risk assessment |
62 |
61 |
$0.00 |
| 69209 |
|
56 |
45 |
$0.00 |
| 90658 |
|
152 |
152 |
$0.00 |
| 90681 |
|
25 |
25 |
$0.00 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
92 |
56 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
17 |
12 |
$0.00 |
| 3051F |
|
14 |
14 |
$0.00 |
| 3046F |
|
66 |
66 |
$0.00 |
| 90670 |
|
81 |
81 |
$0.00 |
| 99078 |
|
31 |
28 |
$0.00 |
| 3045F |
|
14 |
14 |
$0.00 |
| 11400 |
|
12 |
12 |
$0.00 |
| Z6408 |
|
13 |
12 |
$0.00 |
| 99201 |
|
16 |
14 |
$0.00 |
| 90707 |
|
18 |
15 |
$0.00 |