| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
230,680 |
198,227 |
$53.55M |
| 00003 |
Internal/system code - not a standard HCPCS code |
4,890 |
4,262 |
$1.77M |
| D4341 |
|
11,259 |
4,836 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,180 |
5,875 |
$231K |
| D1120 |
Prophylaxis - child |
12,374 |
8,521 |
$224K |
| 90832 |
Psychotherapy, 30 minutes with patient |
10,668 |
6,663 |
$213K |
| 90791 |
Psychiatric diagnostic evaluation |
4,050 |
2,825 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,747 |
9,781 |
$179K |
| D1206 |
Topical application of fluoride varnish |
19,869 |
14,210 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
11,356 |
7,689 |
$127K |
| D4910 |
|
5,044 |
3,457 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
10,178 |
7,327 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,603 |
3,448 |
$112K |
| D1310 |
|
11,601 |
8,831 |
$92K |
| D9430 |
|
14,014 |
10,067 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
24,671 |
17,021 |
$69K |
| D1351 |
Sealant - per tooth |
2,630 |
928 |
$64K |
| D1110 |
Prophylaxis - adult |
3,160 |
2,350 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,936 |
8,845 |
$62K |
| D9999 |
Unspecified adjunctive procedure, by report |
514 |
408 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,379 |
1,405 |
$48K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
86,556 |
69,497 |
$45K |
| D0274 |
Bitewings - four radiographic images |
9,183 |
6,236 |
$43K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,290 |
799 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
944 |
646 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
190 |
143 |
$27K |
| 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 |
701 |
638 |
$23K |
| D0603 |
|
8,523 |
6,117 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,032 |
13,752 |
$15K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,368 |
1,083 |
$15K |
| D4342 |
|
831 |
388 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
32,181 |
25,911 |
$12K |
| D0330 |
Panoramic radiographic image |
4,879 |
4,031 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
512 |
434 |
$9K |
| D0270 |
|
8,553 |
6,043 |
$9K |
| 90480 |
|
1,192 |
1,051 |
$8K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
328 |
303 |
$7K |
| 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 |
554 |
554 |
$7K |
| D0240 |
|
1,249 |
697 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
458 |
328 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
4,152 |
3,378 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,115 |
1,772 |
$6K |
| D2331 |
|
160 |
96 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,098 |
741 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,696 |
2,260 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,268 |
1,060 |
$4K |
| D0602 |
|
890 |
615 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,188 |
2,639 |
$3K |
| D9110 |
|
694 |
605 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
349 |
251 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
383 |
324 |
$3K |
| 96127 |
|
3,083 |
2,811 |
$3K |
| 97802 |
|
910 |
776 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
287 |
228 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
332 |
273 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
18 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17,484 |
14,546 |
$2K |
| 90677 |
|
1,063 |
935 |
$1K |
| 97803 |
|
705 |
566 |
$1K |
| D2335 |
|
36 |
26 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,146 |
5,204 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
8,294 |
7,012 |
$1K |
| 92587 |
|
680 |
574 |
$1K |
| 92015 |
Determination of refractive state |
499 |
432 |
$944.58 |
| D0350 |
|
3,287 |
2,767 |
$919.00 |
| D1354 |
|
83 |
17 |
$918.00 |
| 99383 |
|
628 |
540 |
$827.86 |
| 99381 |
|
119 |
110 |
$745.72 |
| 90739 |
|
215 |
176 |
$709.00 |
| D0601 |
|
271 |
203 |
$702.00 |
| V2020 |
Frames, purchases |
135 |
114 |
$675.37 |
| 93000 |
|
622 |
497 |
$641.40 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
805 |
664 |
$607.87 |
| 92250 |
|
430 |
379 |
$474.77 |
| 85018 |
|
5,330 |
4,411 |
$437.27 |
| G9920 |
Screening performed and negative |
40 |
27 |
$377.00 |
| 99215 |
Prolong outpt/office vis |
1,029 |
872 |
$373.02 |
| 90686 |
|
4,928 |
3,887 |
$371.68 |
| 83655 |
|
630 |
513 |
$315.32 |
| 90697 |
|
426 |
365 |
$279.56 |
| 90656 |
|
1,277 |
1,159 |
$261.27 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
89 |
74 |
$232.50 |
| 99188 |
|
236 |
184 |
$219.42 |
| 90715 |
|
583 |
502 |
$216.19 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$210.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
70 |
56 |
$200.00 |
| 99401 |
|
632 |
534 |
$140.64 |
| D0140 |
Limited oral evaluation - problem focused |
20 |
12 |
$140.00 |
| 99384 |
|
317 |
248 |
$138.64 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
46 |
40 |
$135.00 |
| 0124A |
|
20 |
17 |
$134.00 |
| 92551 |
|
39 |
27 |
$133.62 |
| 81025 |
|
494 |
414 |
$129.65 |
| 92552 |
|
1,315 |
1,124 |
$128.52 |
| G9919 |
Screening performed and positive and provision of recommendations |
21 |
13 |
$116.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
163 |
132 |
$114.18 |
| 99382 |
|
174 |
151 |
$107.34 |
| 17110 |
|
43 |
38 |
$102.77 |
| 80305 |
|
181 |
136 |
$72.00 |
| 81002 |
|
1,110 |
929 |
$62.35 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
18 |
16 |
$60.00 |
| 96160 |
|
485 |
419 |
$46.73 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
124 |
114 |
$42.78 |
| 90633 |
|
1,542 |
1,322 |
$40.54 |
| 82962 |
|
1,036 |
888 |
$38.77 |
| 90653 |
|
66 |
62 |
$20.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
14 |
$10.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
15 |
$10.50 |
| 83026 |
|
116 |
91 |
$7.74 |
| 99442 |
|
1,649 |
1,415 |
$4.95 |
| 99173 |
|
1,567 |
1,348 |
$3.20 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
15 |
12 |
$2.30 |
| 99177 |
|
1,133 |
977 |
$1.87 |
| 3074F |
|
34,920 |
28,872 |
$0.00 |
| 99441 |
|
941 |
789 |
$0.00 |
| 3080F |
|
2,493 |
2,030 |
$0.00 |
| 90723 |
|
496 |
415 |
$0.00 |
| D1330 |
|
16,238 |
13,682 |
$0.00 |
| 3008F |
|
41,766 |
34,833 |
$0.00 |
| 3075F |
|
4,994 |
4,234 |
$0.00 |
| D5899 |
|
831 |
693 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
57 |
55 |
$0.00 |
| 3079F |
|
10,156 |
8,575 |
$0.00 |
| 90696 |
|
68 |
63 |
$0.00 |
| 90716 |
|
462 |
407 |
$0.00 |
| 99443 |
|
961 |
799 |
$0.00 |
| 99403 |
|
132 |
100 |
$0.00 |
| 90651 |
|
703 |
620 |
$0.00 |
| 90744 |
|
50 |
45 |
$0.00 |
| 3044F |
|
520 |
450 |
$0.00 |
| 96161 |
|
15 |
12 |
$0.00 |
| 99402 |
|
29 |
28 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
214 |
205 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
49 |
35 |
$0.00 |
| 1170F |
|
14 |
12 |
$0.00 |
| 90619 |
|
17 |
13 |
$0.00 |
| 90620 |
|
13 |
13 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
55 |
54 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
336 |
330 |
$0.00 |
| 90474 |
|
14 |
12 |
$0.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
14 |
12 |
$0.00 |
| 90694 |
|
56 |
45 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
40 |
37 |
$0.00 |
| D0171 |
|
43 |
28 |
$0.00 |
| 0134A |
|
20 |
16 |
$0.00 |
| D0170 |
|
19 |
14 |
$0.00 |
| D9993 |
|
6,419 |
6,255 |
$0.00 |
| 3078F |
|
34,192 |
28,317 |
$0.00 |
| 1159F |
|
6,303 |
5,423 |
$0.00 |
| 4004F |
|
539 |
521 |
$0.00 |
| D2950 |
|
176 |
156 |
$0.00 |
| 3077F |
|
7,370 |
6,132 |
$0.00 |
| 90670 |
|
481 |
397 |
$0.00 |
| 1160F |
|
6,305 |
5,424 |
$0.00 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
446 |
438 |
$0.00 |
| 91320 |
|
33 |
31 |
$0.00 |
| 90671 |
|
127 |
103 |
$0.00 |
| 90648 |
|
725 |
603 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
164 |
140 |
$0.00 |
| 90713 |
|
234 |
209 |
$0.00 |
| 90681 |
|
38 |
32 |
$0.00 |
| 90710 |
|
187 |
155 |
$0.00 |
| 90734 |
|
357 |
310 |
$0.00 |
| 90707 |
|
75 |
61 |
$0.00 |
| 91321 |
|
387 |
326 |
$0.00 |
| D2999 |
|
222 |
195 |
$0.00 |
| 90700 |
|
59 |
54 |
$0.00 |
| 90672 |
|
91 |
57 |
$0.00 |
| D9996 |
|
97 |
96 |
$0.00 |
| D9990 |
|
204 |
191 |
$0.00 |
| 3046F |
|
42 |
37 |
$0.00 |
| D0191 |
|
433 |
330 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
73 |
52 |
$0.00 |
| 90746 |
|
17 |
14 |
$0.00 |
| 91322 |
|
41 |
33 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
58 |
51 |
$0.00 |
| 3051F |
|
12 |
12 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
29 |
28 |
$0.00 |
| 91313 |
|
36 |
29 |
$0.00 |
| 90662 |
|
16 |
16 |
$0.00 |
| 91312 |
|
21 |
17 |
$0.00 |