| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
81,436 |
54,654 |
$10.26M |
| D0999 |
Unspecified diagnostic procedure, by report |
32,013 |
27,676 |
$3.48M |
| 0071A |
|
465 |
460 |
$20K |
| 0072A |
|
447 |
444 |
$19K |
| 0002A |
|
175 |
157 |
$7K |
| 0064A |
|
169 |
169 |
$7K |
| 0001A |
|
196 |
186 |
$7K |
| 0012A |
|
179 |
176 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
53,628 |
36,534 |
$4K |
| 0011A |
|
232 |
229 |
$4K |
| 0003A |
|
85 |
85 |
$4K |
| 0004A |
|
58 |
58 |
$2K |
| 0054A |
|
44 |
44 |
$2K |
| 90658 |
|
1,985 |
1,497 |
$2K |
| 0013A |
|
20 |
20 |
$842.80 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,805 |
3,238 |
$782.75 |
| 90670 |
|
3,482 |
3,086 |
$422.31 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,237 |
2,858 |
$405.30 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,342 |
3,789 |
$356.75 |
| 90686 |
|
955 |
925 |
$333.43 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,321 |
1,929 |
$298.25 |
| 90633 |
|
1,549 |
1,319 |
$238.09 |
| 90715 |
|
887 |
729 |
$229.20 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,779 |
4,839 |
$207.30 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,487 |
1,373 |
$196.30 |
| 90688 |
|
626 |
611 |
$191.69 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,491 |
1,263 |
$184.77 |
| 90723 |
|
2,751 |
2,427 |
$183.60 |
| 90680 |
|
2,544 |
2,255 |
$165.80 |
| 92551 |
|
1,426 |
1,249 |
$164.80 |
| 90648 |
|
959 |
913 |
$147.40 |
| 76801 |
|
825 |
633 |
$145.80 |
| 90461 |
|
2,175 |
1,933 |
$126.00 |
| 99173 |
|
1,760 |
1,542 |
$122.00 |
| 85018 |
|
2,967 |
2,259 |
$115.60 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,525 |
1,369 |
$114.00 |
| 90647 |
|
2,411 |
2,068 |
$111.63 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,700 |
3,419 |
$104.97 |
| 36415 |
Collection of venous blood by venipuncture |
3,502 |
2,759 |
$92.15 |
| 81002 |
|
1,367 |
1,130 |
$91.00 |
| 81025 |
|
1,165 |
987 |
$79.22 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
708 |
635 |
$76.80 |
| 90700 |
|
493 |
423 |
$75.40 |
| 90707 |
|
707 |
567 |
$65.40 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
594 |
544 |
$58.00 |
| 90716 |
|
728 |
585 |
$47.20 |
| 90657 |
|
1,238 |
885 |
$44.40 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
866 |
746 |
$44.00 |
| D0274 |
Bitewings - four radiographic images |
3,466 |
3,189 |
$33.80 |
| 90651 |
|
170 |
161 |
$31.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
932 |
652 |
$26.00 |
| 90710 |
|
249 |
221 |
$22.00 |
| 59025 |
Fetal non-stress test |
346 |
128 |
$22.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,249 |
3,964 |
$21.05 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
81 |
43 |
$19.62 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
251 |
243 |
$19.00 |
| 82962 |
|
864 |
698 |
$15.68 |
| 96127 |
|
211 |
196 |
$13.00 |
| 90734 |
|
135 |
127 |
$13.00 |
| 90696 |
|
222 |
198 |
$12.00 |
| 90474 |
|
29 |
29 |
$11.00 |
| 90649 |
|
203 |
170 |
$9.00 |
| 99381 |
|
824 |
728 |
$6.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,403 |
2,232 |
$5.60 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
16 |
16 |
$5.00 |
| 81005 |
|
351 |
341 |
$3.44 |
| D0140 |
Limited oral evaluation - problem focused |
2,263 |
2,090 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
4,368 |
4,152 |
$0.00 |
| D0603 |
|
9,047 |
8,284 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
81 |
$0.00 |
| D1351 |
Sealant - per tooth |
5,002 |
2,379 |
$0.00 |
| D2330 |
|
71 |
59 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
14,403 |
13,539 |
$0.00 |
| 3075F |
|
87 |
75 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,942 |
3,525 |
$0.00 |
| D0602 |
|
725 |
676 |
$0.00 |
| 1036F |
|
196 |
182 |
$0.00 |
| 3044F |
|
53 |
52 |
$0.00 |
| D0601 |
|
7,033 |
6,477 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12,498 |
11,975 |
$0.00 |
| 84703 |
|
263 |
200 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
213 |
$0.00 |
| 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 |
318 |
255 |
$0.00 |
| 3008F |
|
737 |
597 |
$0.00 |
| 0503F |
|
118 |
84 |
$0.00 |
| 3079F |
|
223 |
186 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
64 |
56 |
$0.00 |
| 93000 |
|
30 |
29 |
$0.00 |
| 3080F |
|
28 |
25 |
$0.00 |
| 4010F |
|
113 |
106 |
$0.00 |
| D9995 |
|
55 |
44 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
67 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
35 |
18 |
$0.00 |
| D1310 |
|
39 |
32 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$0.00 |
| 3074F |
|
646 |
501 |
$0.00 |
| D2331 |
|
15 |
12 |
$0.00 |
| 59430 |
|
53 |
50 |
$0.00 |
| 99383 |
|
14 |
13 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
21 |
12 |
$0.00 |
| 76830 |
Ultrasound, transvaginal |
31 |
24 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,363 |
919 |
$0.00 |
| D4341 |
|
464 |
288 |
$0.00 |
| D1120 |
Prophylaxis - child |
16,452 |
15,534 |
$0.00 |
| D1110 |
Prophylaxis - adult |
710 |
603 |
$0.00 |
| D9110 |
|
99 |
99 |
$0.00 |
| 0502F |
|
162 |
135 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
178 |
142 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,803 |
3,379 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
122 |
92 |
$0.00 |
| 1159F |
|
164 |
154 |
$0.00 |
| 3078F |
|
601 |
469 |
$0.00 |
| 1160F |
|
150 |
142 |
$0.00 |
| 83026 |
|
228 |
203 |
$0.00 |
| D1354 |
|
187 |
88 |
$0.00 |
| D0180 |
|
158 |
134 |
$0.00 |
| 3077F |
|
129 |
118 |
$0.00 |
| 3046F |
|
15 |
14 |
$0.00 |