| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,293 |
11,860 |
$1.52M |
| 99199 |
Unlisted special service, procedure or report |
74,651 |
49,437 |
$421K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
821 |
642 |
$49K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
694 |
542 |
$42K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
385 |
354 |
$30K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,686 |
2,128 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
328 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
249 |
$21K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,105 |
902 |
$21K |
| D1120 |
Prophylaxis - child |
1,186 |
1,047 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
571 |
$17K |
| D1351 |
Sealant - per tooth |
1,593 |
371 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
889 |
736 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,191 |
1,044 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,144 |
967 |
$10K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
670 |
362 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
977 |
741 |
$7K |
| D0272 |
Bitewings - two radiographic images |
593 |
519 |
$6K |
| D0330 |
Panoramic radiographic image |
198 |
182 |
$6K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
420 |
370 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
87 |
50 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
149 |
149 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
37 |
25 |
$2K |
| D1110 |
Prophylaxis - adult |
65 |
42 |
$1K |
| 87428 |
|
21 |
15 |
$931.66 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
84 |
54 |
$554.67 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$529.02 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
65 |
49 |
$404.82 |
| 90473 |
|
41 |
41 |
$360.00 |
| D1206 |
Topical application of fluoride varnish |
22 |
20 |
$318.82 |
| 81003 |
|
116 |
94 |
$160.24 |
| 92551 |
|
324 |
271 |
$108.61 |
| 90655 |
|
689 |
524 |
$92.22 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
25 |
$83.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
14 |
$76.02 |
| 99173 |
|
795 |
676 |
$69.89 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
15 |
15 |
$65.25 |
| 85018 |
|
14 |
14 |
$42.14 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
13 |
$36.05 |
| 3008F |
|
1,955 |
1,147 |
$0.54 |
| 1160F |
|
90 |
89 |
$0.13 |
| 1159F |
|
90 |
89 |
$0.13 |
| 3074F |
|
68 |
67 |
$0.12 |
| 3078F |
|
70 |
69 |
$0.12 |
| 90649 |
|
200 |
176 |
$0.05 |
| 90656 |
|
100 |
70 |
$0.01 |
| 90686 |
|
34 |
32 |
$0.01 |
| 3352F |
|
167 |
95 |
$0.00 |
| 3351F |
|
538 |
318 |
$0.00 |
| 2000F |
|
72 |
71 |
$0.00 |
| D0602 |
|
18 |
12 |
$0.00 |
| 90688 |
|
259 |
235 |
$0.00 |
| 1000F |
|
1,201 |
673 |
$0.00 |
| 90674 |
|
17 |
15 |
$0.00 |
| 3354F |
|
111 |
56 |
$0.00 |
| D0603 |
|
178 |
133 |
$0.00 |
| 3353F |
|
512 |
271 |
$0.00 |
| 90733 |
|
33 |
27 |
$0.00 |
| 2001F |
|
91 |
90 |
$0.00 |
| 1220F |
|
14 |
14 |
$0.00 |
| 90633 |
|
15 |
13 |
$0.00 |
| 90672 |
|
72 |
60 |
$0.00 |
| 90670 |
|
13 |
12 |
$0.00 |