| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
147,705 |
94,640 |
$22.33M |
| D9450 |
|
75,557 |
44,078 |
$2.03M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
9,216 |
3,945 |
$1.25M |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
3,473 |
2,468 |
$504K |
| D1110 |
Prophylaxis - adult |
22,266 |
15,570 |
$480K |
| 90834 |
Psychotherapy, 45 minutes with patient |
5,571 |
3,038 |
$472K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,872 |
2,859 |
$465K |
| 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 |
11,267 |
9,625 |
$455K |
| 90832 |
Psychotherapy, 30 minutes with patient |
8,958 |
5,314 |
$366K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,390 |
2,326 |
$279K |
| D0210 |
Intraoral - complete series of radiographic images |
9,860 |
7,115 |
$272K |
| D9110 |
|
11,713 |
6,049 |
$253K |
| 99050 |
|
3,031 |
2,801 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,667 |
3,494 |
$152K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
907 |
894 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
12,076 |
8,616 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,836 |
4,996 |
$111K |
| D0274 |
Bitewings - four radiographic images |
6,828 |
4,871 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
12,917 |
7,256 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,709 |
2,427 |
$101K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
581 |
572 |
$87K |
| 90791 |
Psychiatric diagnostic evaluation |
569 |
561 |
$82K |
| 90651 |
|
1,182 |
1,177 |
$81K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
4,957 |
3,121 |
$81K |
| 90882 |
|
1,901 |
1,165 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
3,372 |
1,841 |
$74K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
926 |
919 |
$71K |
| 90837 |
Psychotherapy, 53 minutes with patient |
634 |
361 |
$69K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,249 |
6,248 |
$68K |
| D2330 |
|
2,355 |
1,091 |
$68K |
| D2335 |
|
1,150 |
639 |
$66K |
| D2331 |
|
1,844 |
979 |
$62K |
| G0469 |
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new 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 mental health visit |
325 |
325 |
$57K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,359 |
8,176 |
$56K |
| 90715 |
|
2,088 |
2,071 |
$54K |
| D1120 |
Prophylaxis - child |
1,025 |
996 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,681 |
1,005 |
$50K |
| D0180 |
|
3,571 |
2,870 |
$49K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,360 |
1,633 |
$49K |
| 90686 |
|
3,750 |
3,737 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,680 |
1,626 |
$42K |
| 99442 |
|
1,309 |
1,042 |
$38K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,892 |
1,850 |
$38K |
| 90677 |
|
145 |
145 |
$38K |
| D5212 |
|
178 |
105 |
$37K |
| 90682 |
|
620 |
618 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
125 |
83 |
$35K |
| 90887 |
|
943 |
649 |
$35K |
| 90746 |
|
504 |
501 |
$34K |
| 91322 |
|
197 |
197 |
$28K |
| D4341 |
|
1,199 |
429 |
$27K |
| D4342 |
|
710 |
379 |
$26K |
| D2332 |
|
543 |
297 |
$22K |
| D0330 |
Panoramic radiographic image |
493 |
324 |
$22K |
| D2140 |
|
932 |
483 |
$22K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
930 |
806 |
$22K |
| D5211 |
|
96 |
67 |
$21K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,126 |
3,734 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
621 |
443 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,709 |
1,146 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
187 |
98 |
$15K |
| 81025 |
|
1,963 |
1,855 |
$13K |
| 90480 |
|
256 |
256 |
$12K |
| D3320 |
|
43 |
41 |
$11K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,833 |
1,807 |
$11K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,349 |
1,336 |
$10K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
752 |
733 |
$10K |
| 0124A |
|
208 |
206 |
$9K |
| 90636 |
|
67 |
67 |
$8K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
150 |
148 |
$8K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
726 |
681 |
$7K |
| 93000 |
|
484 |
482 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$6K |
| 90632 |
|
87 |
86 |
$6K |
| D2160 |
|
213 |
101 |
$6K |
| 99443 |
|
136 |
105 |
$6K |
| 90688 |
|
317 |
315 |
$4K |
| 99173 |
|
193 |
192 |
$4K |
| 90673 |
|
48 |
48 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
168 |
167 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
26 |
$4K |
| 0011A |
|
89 |
88 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
363 |
358 |
$3K |
| 81000 |
|
1,082 |
1,033 |
$3K |
| 91320 |
|
23 |
23 |
$3K |
| 99385 |
|
12 |
12 |
$3K |
| D2954 |
|
38 |
26 |
$3K |
| 90670 |
|
38 |
38 |
$3K |
| 0012A |
|
52 |
52 |
$2K |
| 90662 |
|
85 |
79 |
$2K |
| 90716 |
|
58 |
58 |
$2K |
| 99384 |
|
14 |
13 |
$2K |
| 90658 |
|
247 |
242 |
$2K |
| 0064A |
|
45 |
45 |
$2K |
| 81003 |
|
954 |
915 |
$2K |
| D7311 |
|
43 |
25 |
$2K |
| 90732 |
|
14 |
14 |
$1K |
| 99215 |
Prolong outpt/office vis |
13 |
13 |
$1K |
| 90707 |
|
41 |
41 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
104 |
73 |
$1K |
| 90461 |
|
443 |
435 |
$1K |
| 99441 |
|
49 |
46 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$900.46 |
| 98967 |
|
54 |
50 |
$874.43 |
| 86580 |
|
132 |
118 |
$797.28 |
| 96127 |
|
75 |
74 |
$739.44 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
17 |
12 |
$510.31 |
| 90734 |
|
347 |
343 |
$502.17 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
14 |
14 |
$494.62 |
| 90649 |
|
71 |
69 |
$275.18 |
| 82948 |
|
94 |
87 |
$257.18 |
| 81002 |
|
56 |
56 |
$171.92 |
| 92551 |
|
15 |
15 |
$140.70 |
| 83037 |
|
16 |
16 |
$136.96 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
204 |
203 |
$90.00 |
| 91301 |
|
2,452 |
2,378 |
$0.00 |
| D9995 |
|
155 |
83 |
$0.00 |
| 91306 |
|
887 |
884 |
$0.00 |
| H0049 |
Alcohol and/or drug screening |
520 |
518 |
$0.00 |
| P4300 |
|
975 |
533 |
$0.00 |
| D3310 |
|
33 |
24 |
$0.00 |
| 91305 |
|
104 |
101 |
$0.00 |
| 99406 |
|
35 |
34 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
188 |
182 |
$0.00 |
| 91315 |
|
38 |
38 |
$0.00 |
| 91303 |
|
176 |
176 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
88 |
88 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
73 |
73 |
$0.00 |
| 99000 |
|
12 |
12 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
24 |
12 |
$0.00 |
| 90633 |
|
223 |
221 |
$0.00 |
| 91312 |
|
250 |
248 |
$0.00 |
| D9996 |
|
31 |
16 |
$0.00 |
| 90750 |
|
12 |
12 |
$0.00 |