| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
3,089 |
1,753 |
$841K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,301 |
3,865 |
$760K |
| D0140 |
Limited oral evaluation - problem focused |
1,555 |
1,375 |
$691K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,544 |
2,242 |
$593K |
| D0120 |
Periodic oral evaluation - established patient |
981 |
875 |
$321K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,132 |
1,915 |
$285K |
| H0038 |
Self-help/peer services, per 15 minutes |
1,133 |
553 |
$229K |
| D1110 |
Prophylaxis - adult |
914 |
814 |
$199K |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
700 |
287 |
$173K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
995 |
928 |
$170K |
| 90834 |
Psychotherapy, 45 minutes with patient |
580 |
392 |
$157K |
| 90837 |
Psychotherapy, 53 minutes with patient |
913 |
537 |
$145K |
| 0001A |
|
395 |
378 |
$110K |
| D1120 |
Prophylaxis - child |
365 |
335 |
$104K |
| 0002A |
|
365 |
343 |
$98K |
| S0215 |
Non-emergency transportation; mileage, per mile |
1,174 |
663 |
$58K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
871 |
798 |
$39K |
| 0003A |
|
231 |
180 |
$29K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
233 |
222 |
$17K |
| 0071A |
|
42 |
41 |
$13K |
| H0001 |
Alcohol and/or drug assessment |
40 |
37 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
48 |
41 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
27 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$10K |
| 0072A |
|
35 |
34 |
$9K |
| 90686 |
|
743 |
694 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
40 |
28 |
$7K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
59 |
55 |
$7K |
| 91320 |
|
18 |
18 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
54 |
54 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
17 |
$4K |
| H0006 |
Alcohol and/or drug services; case management |
17 |
13 |
$4K |
| 0124A |
|
49 |
46 |
$2K |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
145 |
100 |
$2K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
638 |
603 |
$1K |
| 92015 |
Determination of refractive state |
630 |
560 |
$1K |
| H0002 |
Behavioral health screening to determine eligibility for admission to treatment program |
12 |
12 |
$1K |
| 80053 |
Comprehensive metabolic panel |
377 |
372 |
$1K |
| 84443 |
Thyroid stimulating hormone (TSH) |
204 |
204 |
$846.72 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
265 |
259 |
$646.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
67 |
67 |
$476.56 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$420.00 |
| 84439 |
|
120 |
120 |
$265.02 |
| 80061 |
Lipid panel |
68 |
68 |
$206.14 |
| 81000 |
|
105 |
101 |
$137.69 |
| 36415 |
Collection of venous blood by venipuncture |
1,072 |
997 |
$85.44 |
| D0220 |
Intraoral - periapical first radiographic image |
1,278 |
1,200 |
$66.92 |
| D1206 |
Topical application of fluoride varnish |
2,040 |
1,862 |
$38.91 |
| D1999 |
|
4,037 |
3,411 |
$25.00 |
| 90658 |
|
18 |
18 |
$21.86 |
| D0274 |
Bitewings - four radiographic images |
636 |
552 |
$13.29 |
| 90480 |
|
32 |
32 |
$4.63 |
| D0190 |
|
1,494 |
1,324 |
$0.00 |
| D0191 |
|
42 |
41 |
$0.00 |
| D9990 |
|
207 |
197 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
14 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
18 |
15 |
$0.00 |
| D1330 |
|
3,021 |
2,694 |
$0.00 |
| D1310 |
|
1,734 |
1,604 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
486 |
244 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$0.00 |