| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,929 |
25,369 |
$4.42M |
| D0999 |
Unspecified diagnostic procedure, by report |
5,905 |
4,782 |
$837K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
832 |
620 |
$135K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,957 |
7,976 |
$38K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,630 |
6,202 |
$12K |
| 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 |
762 |
545 |
$11K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
486 |
483 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$5K |
| 0012A |
|
78 |
78 |
$2K |
| 0011A |
|
89 |
80 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
451 |
212 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
467 |
318 |
$259.56 |
| 36415 |
Collection of venous blood by venipuncture |
248 |
238 |
$142.24 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,212 |
1,199 |
$92.98 |
| 99215 |
Prolong outpt/office vis |
58 |
58 |
$92.80 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
320 |
314 |
$10.83 |
| D1110 |
Prophylaxis - adult |
513 |
513 |
$0.00 |
| D1120 |
Prophylaxis - child |
499 |
499 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
853 |
853 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
320 |
318 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
30 |
30 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
66 |
63 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$0.00 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
12 |
12 |
$0.00 |
| H0031 |
Mental health assessment, by non-physician |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
51 |
$0.00 |
| 99173 |
|
36 |
36 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
401 |
401 |
$0.00 |
| D0603 |
|
141 |
141 |
$0.00 |
| 90686 |
|
107 |
106 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,230 |
1,228 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
114 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
147 |
147 |
$0.00 |
| D1330 |
|
335 |
321 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
25 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
25 |
25 |
$0.00 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
14 |
14 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
14 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$0.00 |