| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
71,536 |
49,892 |
$8.91M |
| D0999 |
Unspecified diagnostic procedure, by report |
34,096 |
29,670 |
$3.67M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
42,089 |
30,350 |
$9K |
| 0072A |
|
184 |
183 |
$8K |
| 0071A |
|
175 |
174 |
$7K |
| 0002A |
|
147 |
141 |
$6K |
| 0001A |
|
108 |
105 |
$5K |
| 0064A |
|
42 |
42 |
$2K |
| 90658 |
|
2,004 |
1,634 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,778 |
3,809 |
$1K |
| 0054A |
|
26 |
26 |
$1K |
| 0011A |
|
46 |
46 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,225 |
2,051 |
$814.32 |
| 0003A |
|
17 |
17 |
$716.38 |
| 0012A |
|
14 |
14 |
$534.96 |
| 90649 |
|
419 |
344 |
$519.58 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,446 |
2,954 |
$496.06 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,622 |
1,019 |
$469.72 |
| 92551 |
|
2,887 |
2,667 |
$449.60 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,908 |
2,446 |
$441.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,904 |
3,446 |
$424.00 |
| 90686 |
|
1,701 |
1,649 |
$377.66 |
| 90791 |
Psychiatric diagnostic evaluation |
566 |
457 |
$364.20 |
| 99173 |
|
2,577 |
2,358 |
$322.85 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,334 |
1,219 |
$319.24 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,281 |
3,478 |
$288.75 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,599 |
1,484 |
$212.00 |
| 90670 |
|
2,998 |
2,597 |
$211.60 |
| 90723 |
|
2,318 |
1,994 |
$198.80 |
| 90715 |
|
937 |
807 |
$180.56 |
| 90716 |
|
513 |
417 |
$169.93 |
| 90680 |
|
2,038 |
1,754 |
$160.60 |
| 85018 |
|
2,629 |
2,181 |
$160.40 |
| 90688 |
|
388 |
382 |
$157.64 |
| 90461 |
|
2,010 |
1,874 |
$152.00 |
| 90648 |
|
822 |
783 |
$131.20 |
| 90633 |
|
1,311 |
1,090 |
$124.00 |
| 90734 |
|
498 |
460 |
$94.20 |
| 90647 |
|
2,002 |
1,665 |
$83.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
433 |
331 |
$65.21 |
| 36415 |
Collection of venous blood by venipuncture |
3,798 |
3,076 |
$59.10 |
| 90651 |
|
295 |
264 |
$57.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
627 |
480 |
$49.55 |
| 81025 |
|
717 |
597 |
$47.74 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
277 |
255 |
$41.00 |
| 90707 |
|
512 |
412 |
$34.20 |
| 81002 |
|
346 |
288 |
$31.00 |
| 90700 |
|
364 |
325 |
$26.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
253 |
163 |
$23.00 |
| 90696 |
|
127 |
123 |
$23.00 |
| 90710 |
|
141 |
137 |
$23.00 |
| 82962 |
|
186 |
169 |
$21.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
187 |
166 |
$21.00 |
| 90657 |
|
673 |
494 |
$6.40 |
| 99381 |
|
393 |
335 |
$6.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
703 |
538 |
$0.00 |
| D0601 |
|
8,500 |
7,852 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,153 |
3,573 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,630 |
4,344 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
15,703 |
14,722 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
5,193 |
4,662 |
$0.00 |
| D1351 |
Sealant - per tooth |
7,513 |
2,772 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,224 |
2,034 |
$0.00 |
| D0603 |
|
7,881 |
7,266 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12,652 |
12,099 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
211 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
25 |
$0.00 |
| D0602 |
|
1,623 |
1,504 |
$0.00 |
| 96127 |
|
72 |
67 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
5,607 |
5,246 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
19 |
13 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
861 |
539 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
42 |
$0.00 |
| 81005 |
|
437 |
407 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
15 |
$0.00 |
| 93000 |
|
66 |
61 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
232 |
192 |
$0.00 |
| 3074F |
|
350 |
285 |
$0.00 |
| 3008F |
|
390 |
323 |
$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 |
588 |
487 |
$0.00 |
| 3079F |
|
88 |
79 |
$0.00 |
| 76801 |
|
290 |
175 |
$0.00 |
| 0503F |
|
23 |
13 |
$0.00 |
| D2330 |
|
38 |
33 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
198 |
155 |
$0.00 |
| 3075F |
|
14 |
14 |
$0.00 |
| 86580 |
|
28 |
26 |
$0.00 |
| 4010F |
|
54 |
52 |
$0.00 |
| 94760 |
|
674 |
488 |
$0.00 |
| D1310 |
|
124 |
81 |
$0.00 |
| 59430 |
|
15 |
15 |
$0.00 |
| 1036F |
|
133 |
121 |
$0.00 |
| D2331 |
|
35 |
24 |
$0.00 |
| 3052F |
|
13 |
12 |
$0.00 |
| 3044F |
|
21 |
20 |
$0.00 |
| 1160F |
|
78 |
73 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,116 |
3,521 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,908 |
3,620 |
$0.00 |
| D1120 |
Prophylaxis - child |
17,897 |
16,816 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,298 |
2,111 |
$0.00 |
| D0180 |
|
142 |
116 |
$0.00 |
| D1354 |
|
202 |
81 |
$0.00 |
| D1110 |
Prophylaxis - adult |
638 |
593 |
$0.00 |
| D4341 |
|
1,616 |
873 |
$0.00 |
| 90863 |
|
16 |
14 |
$0.00 |
| 83026 |
|
174 |
152 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
151 |
126 |
$0.00 |
| 1159F |
|
96 |
88 |
$0.00 |
| 3078F |
|
363 |
296 |
$0.00 |
| 0502F |
|
45 |
39 |
$0.00 |
| 3077F |
|
92 |
83 |
$0.00 |
| 87210 |
|
37 |
25 |
$0.00 |
| 3046F |
|
15 |
15 |
$0.00 |
| 59025 |
Fetal non-stress test |
46 |
16 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
49 |
28 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |