| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
122,077 |
87,005 |
$7.24M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
73,714 |
46,399 |
$1.52M |
| 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 |
13,388 |
11,196 |
$251K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,590 |
5,102 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
20,719 |
14,198 |
$166K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
6,113 |
3,842 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,016 |
2,078 |
$147K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,377 |
2,922 |
$137K |
| D1110 |
Prophylaxis - adult |
8,625 |
5,947 |
$135K |
| D1120 |
Prophylaxis - child |
12,872 |
9,012 |
$118K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
8,011 |
5,754 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,242 |
9,205 |
$96K |
| D1351 |
Sealant - per tooth |
5,108 |
1,653 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,992 |
1,097 |
$79K |
| D0330 |
Panoramic radiographic image |
4,431 |
3,372 |
$75K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
9,613 |
6,040 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
957 |
563 |
$50K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,520 |
2,714 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
309 |
191 |
$46K |
| D0274 |
Bitewings - four radiographic images |
6,414 |
4,484 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
6,812 |
4,963 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,516 |
894 |
$42K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,192 |
826 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,826 |
2,055 |
$30K |
| 92015 |
Determination of refractive state |
8,758 |
6,282 |
$27K |
| D0272 |
Bitewings - two radiographic images |
5,231 |
3,759 |
$23K |
| D2140 |
|
990 |
548 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
9,509 |
6,432 |
$21K |
| 99051 |
|
2,642 |
1,636 |
$17K |
| 80305 |
|
3,457 |
1,635 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,864 |
1,531 |
$15K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,383 |
1,673 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,189 |
1,360 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
528 |
500 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
393 |
259 |
$9K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
1,205 |
1,105 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,824 |
794 |
$6K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
8,139 |
6,745 |
$6K |
| D1354 |
|
224 |
91 |
$6K |
| 90686 |
|
2,588 |
1,445 |
$5K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
219 |
125 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
715 |
382 |
$4K |
| 81003 |
|
4,975 |
2,882 |
$4K |
| 99215 |
Prolong outpt/office vis |
57 |
52 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
663 |
447 |
$3K |
| 84443 |
Thyroid stimulating hormone (TSH) |
645 |
431 |
$2K |
| D2335 |
|
22 |
12 |
$2K |
| 99188 |
|
81 |
73 |
$2K |
| 99305 |
|
71 |
53 |
$2K |
| V2020 |
Frames, purchases |
179 |
175 |
$2K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
12 |
12 |
$1K |
| 96127 |
|
794 |
537 |
$1K |
| 80053 |
Comprehensive metabolic panel |
725 |
502 |
$1K |
| D2331 |
|
58 |
36 |
$1K |
| 95165 |
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials |
211 |
85 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
1,541 |
1,003 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
49 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
149 |
130 |
$999.44 |
| 36416 |
|
1,173 |
761 |
$982.52 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
110 |
79 |
$963.75 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
25 |
$924.00 |
| D1320 |
|
111 |
104 |
$920.00 |
| D0240 |
|
98 |
53 |
$919.80 |
| D2330 |
|
42 |
27 |
$914.09 |
| D2160 |
|
35 |
24 |
$887.25 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
487 |
357 |
$866.94 |
| 90677 |
|
187 |
173 |
$586.70 |
| 85018 |
|
719 |
421 |
$579.35 |
| 90710 |
|
566 |
387 |
$515.33 |
| D0270 |
|
350 |
250 |
$400.32 |
| 90473 |
|
668 |
374 |
$392.00 |
| 80061 |
Lipid panel |
355 |
240 |
$359.04 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
303 |
208 |
$342.96 |
| 90670 |
|
3,457 |
2,079 |
$301.15 |
| 96161 |
|
348 |
232 |
$224.83 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
16 |
$220.00 |
| 87430 |
|
18 |
18 |
$201.76 |
| 81025 |
|
204 |
160 |
$142.58 |
| 71046 |
Radiologic examination, chest; 2 views |
98 |
72 |
$142.06 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
50 |
41 |
$98.38 |
| 90723 |
|
2,465 |
1,442 |
$77.59 |
| 90633 |
|
1,112 |
692 |
$64.74 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
268 |
173 |
$63.07 |
| 90648 |
|
3,561 |
2,153 |
$62.49 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
40 |
30 |
$43.50 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
21 |
17 |
$38.93 |
| 85027 |
|
94 |
78 |
$30.13 |
| 82044 |
|
71 |
43 |
$28.26 |
| 82570 |
|
51 |
31 |
$26.65 |
| 74018 |
|
15 |
13 |
$25.81 |
| 90681 |
|
886 |
539 |
$10.83 |
| 90696 |
|
16 |
14 |
$10.00 |
| 3074F |
|
9,778 |
7,526 |
$0.74 |
| 3078F |
|
8,324 |
6,488 |
$0.70 |
| 3079F |
|
1,170 |
893 |
$0.08 |
| 90744 |
|
69 |
63 |
$0.02 |
| 90698 |
|
121 |
106 |
$0.01 |
| 1036F |
|
3,330 |
2,720 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
2,928 |
1,810 |
$0.00 |
| 3008F |
|
13,683 |
9,868 |
$0.00 |
| 3075F |
|
195 |
174 |
$0.00 |
| 1111F |
|
32 |
24 |
$0.00 |
| G8433 |
Screening for depression not completed, documented patient or medical reason |
314 |
260 |
$0.00 |
| 3080F |
|
83 |
64 |
$0.00 |
| 90656 |
|
28 |
27 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
17 |
14 |
$0.00 |
| 3044F |
|
77 |
62 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
55 |
42 |
$0.00 |
| 3077F |
|
123 |
91 |
$0.00 |
| 4004F |
|
439 |
355 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
19 |
18 |
$0.00 |
| 90734 |
|
37 |
26 |
$0.00 |
| 90649 |
|
15 |
13 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
162 |
127 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
16 |
16 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
49 |
43 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 83721 |
|
20 |
16 |
$0.00 |