| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
57,225 |
48,954 |
$9.10M |
| D9450 |
|
131,149 |
72,919 |
$3.93M |
| D7140 |
Extraction, erupted tooth or exposed root |
21,407 |
6,439 |
$961K |
| D1110 |
Prophylaxis - adult |
28,035 |
19,703 |
$771K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,905 |
9,905 |
$646K |
| D0140 |
Limited oral evaluation - problem focused |
23,230 |
13,562 |
$530K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,508 |
7,728 |
$478K |
| D0210 |
Intraoral - complete series of radiographic images |
12,613 |
8,904 |
$450K |
| D0330 |
Panoramic radiographic image |
10,996 |
6,882 |
$434K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
2,554 |
1,594 |
$331K |
| 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 |
9,092 |
7,705 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
24,689 |
17,669 |
$294K |
| D0274 |
Bitewings - four radiographic images |
15,619 |
11,193 |
$285K |
| 99050 |
|
5,393 |
5,029 |
$264K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,242 |
3,396 |
$222K |
| D2331 |
|
4,863 |
2,494 |
$206K |
| 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 |
2,419 |
1,441 |
$198K |
| D2330 |
|
5,168 |
2,221 |
$191K |
| D0220 |
Intraoral - periapical first radiographic image |
21,892 |
12,781 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,018 |
6,379 |
$182K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,169 |
835 |
$172K |
| D9110 |
|
7,114 |
4,257 |
$166K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,071 |
8,340 |
$123K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,075 |
1,402 |
$93K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
529 |
525 |
$93K |
| D2332 |
|
1,551 |
860 |
$88K |
| D2335 |
|
1,123 |
663 |
$82K |
| D1120 |
Prophylaxis - child |
1,568 |
1,505 |
$76K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
218 |
189 |
$68K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
3,645 |
2,830 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,665 |
2,507 |
$62K |
| D7230 |
|
351 |
200 |
$60K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,727 |
17,002 |
$56K |
| D1351 |
Sealant - per tooth |
1,443 |
360 |
$53K |
| D5110 |
|
111 |
80 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,904 |
2,430 |
$43K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
422 |
422 |
$39K |
| D2394 |
|
705 |
381 |
$33K |
| D4341 |
|
1,072 |
373 |
$33K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,668 |
5,544 |
$31K |
| D0180 |
|
1,844 |
1,029 |
$29K |
| D5212 |
|
127 |
70 |
$28K |
| 90674 |
|
2,025 |
2,001 |
$26K |
| 90715 |
|
830 |
827 |
$25K |
| 80305 |
|
2,579 |
2,074 |
$21K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
831 |
818 |
$18K |
| D5120 |
|
53 |
27 |
$16K |
| 99051 |
|
969 |
895 |
$15K |
| D0270 |
|
2,028 |
1,649 |
$14K |
| 90746 |
|
205 |
205 |
$14K |
| D0272 |
Bitewings - two radiographic images |
786 |
597 |
$13K |
| D5211 |
|
55 |
27 |
$12K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
95 |
95 |
$11K |
| 90686 |
|
803 |
801 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
54 |
54 |
$9K |
| 0134A |
|
178 |
176 |
$7K |
| 99173 |
|
250 |
250 |
$6K |
| 90677 |
|
31 |
31 |
$5K |
| 90651 |
|
103 |
79 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
616 |
610 |
$4K |
| 90480 |
|
92 |
92 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
108 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
447 |
447 |
$3K |
| 90661 |
|
190 |
190 |
$3K |
| 90750 |
|
226 |
225 |
$2K |
| D7220 |
|
19 |
13 |
$2K |
| D4342 |
|
63 |
25 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,186 |
1,094 |
$2K |
| D7310 |
|
40 |
12 |
$2K |
| 91322 |
|
150 |
150 |
$2K |
| 90694 |
|
246 |
243 |
$2K |
| 81002 |
|
586 |
559 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,092 |
2,466 |
$1K |
| 81025 |
|
123 |
122 |
$775.20 |
| D1354 |
|
42 |
12 |
$615.00 |
| 90620 |
|
20 |
16 |
$580.00 |
| 93000 |
|
25 |
25 |
$383.75 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
14 |
13 |
$242.63 |
| 90734 |
|
17 |
14 |
$183.87 |
| G0008 |
Administration of influenza virus vaccine |
356 |
354 |
$140.00 |
| 90653 |
|
76 |
76 |
$119.06 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
380 |
354 |
$101.24 |
| 86580 |
|
12 |
12 |
$72.48 |
| D9995 |
|
981 |
504 |
$0.00 |
| 91306 |
|
153 |
129 |
$0.00 |
| 91301 |
|
454 |
441 |
$0.00 |
| 82962 |
|
113 |
96 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
38 |
38 |
$0.00 |
| 91305 |
|
25 |
25 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
25 |
13 |
$0.00 |
| D0350 |
|
220 |
121 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
63 |
62 |
$0.00 |
| 91300 |
|
1,083 |
1,045 |
$0.00 |
| 91313 |
|
249 |
247 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
50 |
50 |
$0.00 |
| 90713 |
|
20 |
12 |
$0.00 |
| 91312 |
|
38 |
36 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
42 |
24 |
$0.00 |