| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
78,185 |
70,220 |
$18.77M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28,727 |
26,616 |
$158K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,584 |
6,340 |
$77K |
| D9999 |
Unspecified adjunctive procedure, by report |
138 |
137 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,227 |
1,226 |
$38K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,113 |
2,987 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
890 |
890 |
$22K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,031 |
2,027 |
$21K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,640 |
2,639 |
$19K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,962 |
6,936 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
96 |
$15K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,426 |
4,422 |
$15K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,095 |
1,095 |
$14K |
| 90832 |
Psychotherapy, 30 minutes with patient |
232 |
156 |
$12K |
| V2020 |
Frames, purchases |
1,232 |
1,231 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,896 |
1,896 |
$9K |
| 0012A |
|
193 |
193 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
812 |
812 |
$5K |
| 0011A |
|
154 |
154 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
53 |
$4K |
| 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 |
130 |
122 |
$4K |
| 0111A |
|
65 |
65 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
151 |
151 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
55 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
822 |
822 |
$1K |
| 0071A |
|
33 |
33 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$1K |
| 90474 |
|
540 |
457 |
$1K |
| 92015 |
Determination of refractive state |
1,728 |
1,728 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
38 |
38 |
$844.10 |
| 0072A |
|
17 |
17 |
$680.00 |
| 87428 |
|
237 |
236 |
$675.97 |
| D1120 |
Prophylaxis - child |
1,351 |
1,351 |
$670.78 |
| D0274 |
Bitewings - four radiographic images |
519 |
519 |
$619.79 |
| 99381 |
|
85 |
85 |
$575.70 |
| D1206 |
Topical application of fluoride varnish |
1,693 |
1,693 |
$535.96 |
| 80305 |
|
466 |
444 |
$530.20 |
| 90656 |
|
38 |
38 |
$523.25 |
| D0120 |
Periodic oral evaluation - established patient |
1,283 |
1,283 |
$471.64 |
| 99406 |
|
29 |
28 |
$365.69 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$320.85 |
| D1110 |
Prophylaxis - adult |
332 |
332 |
$275.64 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$237.15 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
518 |
518 |
$111.22 |
| 81025 |
|
549 |
543 |
$101.58 |
| 90686 |
|
1,025 |
1,025 |
$83.72 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
27 |
$61.95 |
| 90715 |
|
100 |
100 |
$4.37 |
| 90674 |
|
1,291 |
1,291 |
$0.01 |
| 90633 |
|
750 |
750 |
$0.01 |
| 3008F |
|
3,484 |
3,284 |
$0.00 |
| 1125F |
|
105 |
105 |
$0.00 |
| 90647 |
|
1,522 |
1,522 |
$0.00 |
| 90723 |
|
1,573 |
1,573 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,237 |
1,236 |
$0.00 |
| 3074F |
|
2,204 |
2,082 |
$0.00 |
| 1111F |
|
3,495 |
3,205 |
$0.00 |
| 90651 |
|
484 |
484 |
$0.00 |
| 1126F |
|
519 |
511 |
$0.00 |
| 90716 |
|
79 |
79 |
$0.00 |
| 3079F |
|
219 |
212 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
92 |
92 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
107 |
107 |
$0.00 |
| 87807 |
|
14 |
14 |
$0.00 |
| 99385 |
|
44 |
44 |
$0.00 |
| 90677 |
|
94 |
94 |
$0.00 |
| 3080F |
|
12 |
12 |
$0.00 |
| 90620 |
|
14 |
14 |
$0.00 |
| 88720 |
|
44 |
39 |
$0.00 |
| 99386 |
|
12 |
12 |
$0.00 |
| 3075F |
|
42 |
41 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
43 |
43 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 90734 |
|
166 |
166 |
$0.00 |
| 90670 |
|
1,356 |
1,356 |
$0.00 |
| 90681 |
|
697 |
696 |
$0.00 |
| 3078F |
|
1,980 |
1,881 |
$0.00 |
| 90671 |
|
623 |
623 |
$0.00 |
| 90661 |
|
223 |
223 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
188 |
188 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
58 |
51 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
207 |
207 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
66 |
66 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
440 |
439 |
$0.00 |
| 87210 |
|
26 |
26 |
$0.00 |
| 90687 |
|
32 |
32 |
$0.00 |
| 99188 |
|
133 |
133 |
$0.00 |
| 90700 |
|
30 |
30 |
$0.00 |
| 90707 |
|
54 |
54 |
$0.00 |
| 90710 |
|
36 |
36 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
17 |
17 |
$0.00 |
| 3077F |
|
14 |
13 |
$0.00 |