| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
50,565 |
31,265 |
$2.38M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34,636 |
20,183 |
$576K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,039 |
5,076 |
$202K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,667 |
3,214 |
$82K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,396 |
3,462 |
$60K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,488 |
923 |
$40K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,565 |
936 |
$37K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
769 |
511 |
$21K |
| 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 |
1,087 |
853 |
$15K |
| 81025 |
|
4,637 |
3,156 |
$14K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
362 |
236 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
3,375 |
2,517 |
$9K |
| 81002 |
|
7,079 |
4,883 |
$8K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
381 |
203 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
971 |
728 |
$8K |
| 92551 |
|
2,385 |
1,775 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
865 |
525 |
$7K |
| 90715 |
|
427 |
344 |
$6K |
| 87210 |
|
2,581 |
1,634 |
$5K |
| D0330 |
Panoramic radiographic image |
1,313 |
1,004 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,683 |
1,248 |
$4K |
| 90651 |
|
481 |
345 |
$3K |
| 99384 |
|
89 |
54 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,104 |
2,253 |
$2K |
| 90670 |
|
71 |
54 |
$2K |
| D1110 |
Prophylaxis - adult |
545 |
437 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
96 |
64 |
$1K |
| 90633 |
|
95 |
77 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
410 |
290 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
70 |
44 |
$1K |
| 99383 |
|
28 |
14 |
$889.09 |
| D0274 |
Bitewings - four radiographic images |
866 |
643 |
$780.00 |
| 86580 |
|
307 |
217 |
$710.46 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
14 |
$460.89 |
| D1120 |
Prophylaxis - child |
155 |
118 |
$440.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
143 |
$420.00 |
| D0120 |
Periodic oral evaluation - established patient |
191 |
155 |
$392.84 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
752 |
495 |
$256.04 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
38 |
25 |
$195.07 |
| 90648 |
|
21 |
12 |
$188.66 |
| D0230 |
Intraoral - periapical each additional radiographic image |
147 |
63 |
$45.00 |
| 82948 |
|
26 |
18 |
$11.34 |
| 90688 |
|
669 |
520 |
$2.01 |
| 90734 |
|
357 |
261 |
$1.25 |
| 90620 |
|
43 |
29 |
$0.25 |
| 90686 |
|
44 |
39 |
$0.20 |
| 90710 |
|
50 |
29 |
$0.13 |
| 90696 |
|
24 |
14 |
$0.06 |
| 90461 |
|
777 |
586 |
$0.00 |
| 99173 |
|
55 |
45 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
65 |
32 |
$0.00 |
| 90672 |
|
13 |
13 |
$0.00 |
| 3080F |
|
161 |
91 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$0.00 |
| 1111F |
|
22 |
19 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$0.00 |