| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,412 |
7,222 |
$1.76M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,790 |
11,448 |
$193K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,395 |
4,886 |
$115K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,511 |
6,289 |
$65K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
144 |
144 |
$52K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,024 |
2,912 |
$45K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,411 |
2,359 |
$31K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
832 |
810 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
606 |
572 |
$26K |
| 99222 |
Initial hospital care, per day, moderate complexity |
204 |
202 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
957 |
887 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
265 |
262 |
$10K |
| 99429 |
|
1,259 |
1,252 |
$9K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
276 |
204 |
$9K |
| 92551 |
|
1,810 |
1,781 |
$7K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
206 |
205 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
338 |
327 |
$5K |
| 99173 |
|
1,814 |
1,784 |
$4K |
| D1120 |
Prophylaxis - child |
490 |
467 |
$4K |
| 90686 |
|
941 |
896 |
$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 |
603 |
513 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
95 |
49 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,249 |
1,183 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
72 |
72 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
110 |
$2K |
| 99401 |
|
176 |
158 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
189 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
688 |
498 |
$991.50 |
| D1110 |
Prophylaxis - adult |
103 |
101 |
$933.00 |
| 90656 |
|
256 |
248 |
$909.84 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
31 |
27 |
$895.79 |
| 90671 |
|
36 |
36 |
$860.04 |
| 99441 |
|
133 |
130 |
$852.78 |
| D1351 |
Sealant - per tooth |
103 |
28 |
$608.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
102 |
$590.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
28 |
$579.00 |
| 90658 |
|
37 |
37 |
$567.45 |
| D0274 |
Bitewings - four radiographic images |
137 |
134 |
$549.00 |
| 90670 |
|
462 |
439 |
$522.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
57 |
53 |
$446.22 |
| 96127 |
|
312 |
304 |
$366.90 |
| 82962 |
|
547 |
491 |
$363.33 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$355.00 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$270.00 |
| 99442 |
|
27 |
27 |
$248.45 |
| 90633 |
|
99 |
97 |
$236.32 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
95 |
46 |
$198.72 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$149.25 |
| 99381 |
|
947 |
947 |
$141.97 |
| D0601 |
|
30 |
30 |
$130.00 |
| D0602 |
|
25 |
25 |
$120.00 |
| 90474 |
|
12 |
12 |
$112.46 |
| 90680 |
|
60 |
55 |
$92.44 |
| D1330 |
|
538 |
508 |
$74.00 |
| 81002 |
|
720 |
417 |
$73.62 |
| 90723 |
|
229 |
227 |
$72.25 |
| 3008F |
|
213 |
203 |
$70.00 |
| 90677 |
|
13 |
13 |
$69.84 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$56.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
13 |
12 |
$20.00 |
| 3074F |
|
16 |
13 |
$1.00 |
| 99072 |
|
40 |
40 |
$0.00 |
| 90681 |
|
102 |
102 |
$0.00 |
| 90648 |
|
13 |
13 |
$0.00 |
| 80061 |
Lipid panel |
50 |
50 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
26 |
26 |
$0.00 |
| 90647 |
|
231 |
227 |
$0.00 |
| 90697 |
|
54 |
54 |
$0.00 |
| 99383 |
|
12 |
12 |
$0.00 |
| D1310 |
|
53 |
51 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
139 |
139 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| H0033 |
Oral medication administration, direct observation |
12 |
12 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
14 |
13 |
$0.00 |