| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,414 |
16,451 |
$4.22M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
119,568 |
103,432 |
$2.78M |
| D0120 |
Periodic oral evaluation - established patient |
15,648 |
14,285 |
$688K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,427 |
15,043 |
$453K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
17,936 |
17,593 |
$395K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
20,062 |
18,690 |
$395K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,349 |
5,318 |
$238K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,491 |
4,463 |
$219K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,013 |
4,972 |
$204K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,790 |
3,716 |
$137K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
11,024 |
10,721 |
$115K |
| 90461 |
|
5,584 |
5,482 |
$102K |
| D1110 |
Prophylaxis - adult |
9,399 |
9,327 |
$101K |
| 92587 |
|
7,089 |
5,943 |
$100K |
| 90697 |
|
1,185 |
1,136 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,995 |
3,164 |
$82K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,762 |
1,752 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,515 |
4,471 |
$64K |
| D1120 |
Prophylaxis - child |
5,722 |
5,648 |
$61K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,459 |
1,446 |
$52K |
| 90671 |
|
889 |
809 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,816 |
1,583 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
5,471 |
5,319 |
$47K |
| 90686 |
|
8,002 |
7,749 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
16,700 |
16,216 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
2,425 |
2,405 |
$40K |
| 90651 |
|
917 |
853 |
$39K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,694 |
1,676 |
$35K |
| 90619 |
|
360 |
355 |
$34K |
| 90677 |
|
207 |
207 |
$33K |
| D0274 |
Bitewings - four radiographic images |
5,745 |
5,661 |
$30K |
| 99457 |
|
1,280 |
1,240 |
$27K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,021 |
2,911 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,077 |
10,901 |
$23K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
526 |
518 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,642 |
1,635 |
$20K |
| D1351 |
Sealant - per tooth |
2,170 |
676 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,153 |
2,129 |
$18K |
| 97802 |
|
422 |
422 |
$16K |
| 92551 |
|
2,715 |
2,714 |
$14K |
| 99454 |
|
535 |
520 |
$14K |
| 90715 |
|
513 |
492 |
$14K |
| 80305 |
|
1,841 |
1,537 |
$13K |
| 90620 |
|
317 |
297 |
$12K |
| 99173 |
|
3,365 |
3,321 |
$10K |
| 99215 |
Prolong outpt/office vis |
297 |
288 |
$10K |
| 99429 |
|
996 |
993 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
299 |
261 |
$10K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
816 |
809 |
$8K |
| 90750 |
|
60 |
56 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
232 |
$8K |
| 0012A |
|
282 |
282 |
$8K |
| 81002 |
|
17,497 |
12,548 |
$8K |
| 81025 |
|
1,841 |
1,790 |
$7K |
| 0011A |
|
280 |
279 |
$6K |
| D2140 |
|
191 |
166 |
$6K |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
49 |
49 |
$5K |
| 99188 |
|
425 |
419 |
$5K |
| D0602 |
|
661 |
655 |
$5K |
| 97803 |
|
171 |
171 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
463 |
457 |
$4K |
| 90656 |
|
626 |
624 |
$4K |
| 90633 |
|
1,298 |
1,214 |
$3K |
| D9110 |
|
372 |
368 |
$3K |
| 90670 |
|
792 |
766 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
2,132 |
2,068 |
$3K |
| D0601 |
|
389 |
383 |
$3K |
| D0272 |
Bitewings - two radiographic images |
553 |
551 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
598 |
594 |
$3K |
| 3008F |
|
261 |
261 |
$3K |
| 90734 |
|
118 |
118 |
$2K |
| 11721 |
|
151 |
144 |
$2K |
| 90658 |
|
570 |
570 |
$2K |
| 90674 |
|
89 |
89 |
$2K |
| D2330 |
|
46 |
42 |
$2K |
| 95251 |
|
156 |
145 |
$2K |
| 99453 |
|
165 |
162 |
$1K |
| 99458 |
|
70 |
67 |
$1K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
373 |
373 |
$1K |
| 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 |
367 |
313 |
$1K |
| 90716 |
|
110 |
99 |
$1K |
| 82947 |
|
489 |
449 |
$1K |
| 90473 |
|
84 |
84 |
$955.92 |
| 59430 |
|
12 |
12 |
$899.16 |
| D2940 |
|
102 |
89 |
$672.00 |
| 90680 |
|
879 |
846 |
$630.32 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
72 |
72 |
$556.00 |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$534.75 |
| 99385 |
|
13 |
13 |
$509.68 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
226 |
217 |
$491.62 |
| 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 |
1,258 |
1,015 |
$442.62 |
| 58100 |
|
12 |
12 |
$433.39 |
| 90710 |
|
12 |
12 |
$400.00 |
| 90662 |
|
18 |
18 |
$286.53 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
49 |
43 |
$270.42 |
| 99401 |
|
16 |
16 |
$240.07 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$226.15 |
| D0603 |
|
33 |
33 |
$190.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$180.00 |
| 0502F |
|
4,386 |
2,820 |
$157.50 |
| 90791 |
Psychiatric diagnostic evaluation |
652 |
652 |
$117.32 |
| 90672 |
|
99 |
98 |
$104.19 |
| 90660 |
|
57 |
57 |
$77.07 |
| 90707 |
|
17 |
12 |
$60.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$44.00 |
| 82270 |
|
26 |
26 |
$34.94 |
| 99000 |
|
31 |
31 |
$3.88 |
| D1310 |
|
342 |
335 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,300 |
2,027 |
$0.00 |
| 86580 |
|
525 |
510 |
$0.00 |
| D1330 |
|
348 |
341 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 90744 |
|
83 |
79 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
42 |
42 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
18 |
18 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,464 |
1,087 |
$0.00 |
| D9430 |
|
72 |
71 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| D1999 |
|
65 |
49 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |