| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
48,383 |
36,173 |
$3.61M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
21,816 |
12,740 |
$392K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
18,657 |
11,750 |
$302K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,398 |
5,038 |
$228K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
7,926 |
4,966 |
$161K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,701 |
2,264 |
$102K |
| 90677 |
|
526 |
451 |
$64K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,273 |
1,342 |
$58K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,483 |
439 |
$51K |
| 90686 |
|
6,327 |
3,795 |
$34K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,655 |
970 |
$19K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,926 |
2,817 |
$18K |
| D1206 |
Topical application of fluoride varnish |
2,116 |
1,252 |
$12K |
| 90670 |
|
5,556 |
3,597 |
$11K |
| 99401 |
|
550 |
517 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
293 |
176 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,453 |
854 |
$9K |
| 90698 |
|
4,983 |
3,242 |
$9K |
| 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 |
551 |
511 |
$7K |
| 90633 |
|
2,336 |
1,544 |
$7K |
| 99381 |
|
531 |
400 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,004 |
583 |
$6K |
| 90671 |
|
99 |
73 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,251 |
1,855 |
$5K |
| 90651 |
|
101 |
67 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,653 |
853 |
$3K |
| 90756 |
|
278 |
162 |
$3K |
| 90744 |
|
2,606 |
1,728 |
$3K |
| 90688 |
|
614 |
387 |
$3K |
| 90681 |
|
2,365 |
1,521 |
$3K |
| 96160 |
|
2,299 |
1,236 |
$3K |
| D1351 |
Sealant - per tooth |
1,681 |
363 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
175 |
93 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
121 |
55 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
1,967 |
1,162 |
$2K |
| 90716 |
|
533 |
421 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,121 |
1,465 |
$2K |
| D0330 |
Panoramic radiographic image |
1,625 |
946 |
$1K |
| 90707 |
|
493 |
389 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
2,248 |
1,767 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,666 |
1,688 |
$1K |
| D1110 |
Prophylaxis - adult |
1,243 |
818 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
286 |
134 |
$1K |
| 90715 |
|
188 |
105 |
$1K |
| 99402 |
|
32 |
30 |
$1K |
| 90734 |
|
31 |
24 |
$871.04 |
| 0012A |
|
32 |
32 |
$766.53 |
| 90832 |
Psychotherapy, 30 minutes with patient |
34 |
12 |
$730.83 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,329 |
1,094 |
$695.72 |
| 90700 |
|
228 |
148 |
$586.10 |
| 90648 |
|
170 |
120 |
$582.00 |
| D1120 |
Prophylaxis - child |
1,169 |
1,062 |
$567.00 |
| 0011A |
|
38 |
37 |
$559.02 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
911 |
591 |
$387.38 |
| 99188 |
|
467 |
402 |
$375.00 |
| 90685 |
|
682 |
478 |
$330.00 |
| 90710 |
|
165 |
92 |
$322.00 |
| 0124A |
|
18 |
12 |
$303.16 |
| 90658 |
|
388 |
259 |
$231.96 |
| 90696 |
|
95 |
53 |
$197.50 |
| 90656 |
|
156 |
155 |
$148.80 |
| D0270 |
|
22 |
14 |
$40.00 |
| 3078F |
|
6,476 |
4,616 |
$30.07 |
| 3074F |
|
6,043 |
4,905 |
$30.06 |
| 3077F |
|
287 |
183 |
$18.10 |
| 3079F |
|
1,545 |
1,138 |
$11.62 |
| 3080F |
|
55 |
36 |
$5.30 |
| 3075F |
|
628 |
481 |
$5.08 |
| 3008F |
|
8,473 |
5,326 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
426 |
412 |
$0.00 |
| 91301 |
|
76 |
75 |
$0.00 |
| D0602 |
|
41 |
32 |
$0.00 |
| D0603 |
|
40 |
29 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
32 |
$0.00 |
| D1354 |
|
226 |
82 |
$0.00 |
| 91312 |
|
18 |
12 |
$0.00 |