| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
51,124 |
36,548 |
$4.09M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14,009 |
11,443 |
$188K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,818 |
8,250 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,642 |
5,291 |
$75K |
| D1120 |
Prophylaxis - child |
7,341 |
5,053 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
10,062 |
7,095 |
$55K |
| D1110 |
Prophylaxis - adult |
4,938 |
3,553 |
$49K |
| D1206 |
Topical application of fluoride varnish |
4,522 |
2,740 |
$39K |
| D0330 |
Panoramic radiographic image |
2,382 |
1,713 |
$24K |
| D0274 |
Bitewings - four radiographic images |
2,215 |
1,617 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,047 |
584 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
748 |
338 |
$16K |
| 99215 |
Prolong outpt/office vis |
206 |
184 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,116 |
3,038 |
$14K |
| 90732 |
|
129 |
124 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,948 |
1,522 |
$12K |
| D0272 |
Bitewings - two radiographic images |
4,646 |
3,430 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
6,636 |
4,543 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,983 |
3,179 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
854 |
509 |
$10K |
| 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 |
1,717 |
1,550 |
$9K |
| 90686 |
|
1,403 |
1,064 |
$7K |
| 90837 |
Psychotherapy, 53 minutes with patient |
263 |
146 |
$6K |
| 93000 |
|
787 |
601 |
$6K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,823 |
1,591 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
119 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
166 |
158 |
$3K |
| 90715 |
|
196 |
145 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
377 |
272 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
204 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
370 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
193 |
76 |
$2K |
| 82962 |
|
3,405 |
2,843 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
138 |
116 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
97 |
80 |
$2K |
| 36416 |
|
2,359 |
2,034 |
$1K |
| 90656 |
|
53 |
52 |
$940.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
773 |
700 |
$905.32 |
| 90832 |
Psychotherapy, 30 minutes with patient |
14 |
12 |
$779.94 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
102 |
80 |
$630.94 |
| 90834 |
Psychotherapy, 45 minutes with patient |
126 |
73 |
$279.45 |
| 99401 |
|
13 |
13 |
$277.80 |
| 80305 |
|
26 |
25 |
$232.40 |
| G0008 |
Administration of influenza virus vaccine |
28 |
28 |
$166.23 |
| 81002 |
|
139 |
118 |
$162.28 |
| 81025 |
|
35 |
29 |
$142.02 |
| 90633 |
|
15 |
14 |
$141.75 |
| 90651 |
|
18 |
17 |
$126.00 |
| 90734 |
|
20 |
20 |
$126.00 |
| 90621 |
|
13 |
13 |
$94.50 |
| 90682 |
|
14 |
12 |
$65.26 |
| 81000 |
|
119 |
114 |
$52.88 |
| 85018 |
|
42 |
41 |
$30.60 |
| 3044F |
|
69 |
66 |
$20.00 |
| 88142 |
|
13 |
12 |
$16.88 |
| 97803 |
|
17 |
15 |
$12.04 |
| 3079F |
|
843 |
802 |
$0.00 |
| 1036F |
|
1,260 |
1,158 |
$0.00 |
| 3074F |
|
1,237 |
1,178 |
$0.00 |
| 1126F |
|
431 |
407 |
$0.00 |
| 3008F |
|
2,334 |
2,173 |
$0.00 |
| 2001F |
|
2,335 |
2,174 |
$0.00 |
| 3075F |
|
469 |
457 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
316 |
290 |
$0.00 |
| 1034F |
|
948 |
879 |
$0.00 |
| 3048F |
|
69 |
66 |
$0.00 |
| 1111F |
|
286 |
263 |
$0.00 |
| 99384 |
|
16 |
16 |
$0.00 |
| 3080F |
|
91 |
87 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
39 |
34 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
41 |
40 |
$0.00 |
| 92551 |
|
50 |
50 |
$0.00 |
| 1125F |
|
340 |
319 |
$0.00 |
| 3049F |
|
42 |
41 |
$0.00 |
| 4004F |
|
320 |
308 |
$0.00 |
| 3077F |
|
203 |
184 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
278 |
256 |
$0.00 |
| 1159F |
|
906 |
837 |
$0.00 |
| 3078F |
|
908 |
868 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
47 |
43 |
$0.00 |
| 99382 |
|
39 |
38 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
46 |
41 |
$0.00 |
| 99173 |
|
47 |
47 |
$0.00 |
| 99177 |
|
33 |
33 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
14 |
12 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
54 |
54 |
$0.00 |