| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
158,497 |
127,464 |
$36.09M |
| 00003 |
Internal/system code - not a standard HCPCS code |
1,607 |
1,236 |
$416K |
| 90832 |
Psychotherapy, 30 minutes with patient |
9,918 |
4,717 |
$232K |
| D1110 |
Prophylaxis - adult |
5,840 |
5,839 |
$184K |
| D1120 |
Prophylaxis - child |
3,751 |
3,741 |
$159K |
| D1206 |
Topical application of fluoride varnish |
10,427 |
10,415 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,513 |
5,508 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,659 |
2,368 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
6,503 |
6,497 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
4,715 |
4,712 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,666 |
2,288 |
$83K |
| 90791 |
Psychiatric diagnostic evaluation |
1,060 |
839 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,330 |
6,161 |
$62K |
| G9012 |
Other specified case management service not elsewhere classified |
404 |
277 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
9,085 |
8,438 |
$44K |
| D1351 |
Sealant - per tooth |
1,359 |
421 |
$42K |
| D0274 |
Bitewings - four radiographic images |
4,979 |
4,977 |
$39K |
| D9430 |
|
3,427 |
3,335 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
157 |
137 |
$18K |
| 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 |
181 |
155 |
$16K |
| D4341 |
|
424 |
195 |
$14K |
| 98940 |
|
7,083 |
3,835 |
$12K |
| 90785 |
|
1,216 |
627 |
$10K |
| 90834 |
Psychotherapy, 45 minutes with patient |
280 |
155 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
207 |
156 |
$6K |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
2,920 |
1,640 |
$4K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,598 |
23,226 |
$4K |
| D0270 |
|
1,695 |
1,680 |
$3K |
| D2330 |
|
60 |
45 |
$2K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
69 |
51 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$870.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
38 |
34 |
$741.58 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$535.80 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,499 |
6,923 |
$519.57 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,970 |
3,795 |
$469.18 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
11,884 |
10,590 |
$464.01 |
| D2331 |
|
18 |
18 |
$460.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$350.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,066 |
2,006 |
$326.62 |
| 90677 |
|
187 |
171 |
$297.18 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
802 |
768 |
$268.71 |
| 90686 |
|
646 |
601 |
$153.00 |
| 97802 |
|
931 |
887 |
$147.05 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
96 |
83 |
$98.75 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
27 |
24 |
$84.00 |
| D0602 |
|
89 |
89 |
$79.00 |
| 92552 |
|
3,209 |
3,093 |
$71.12 |
| 90723 |
|
221 |
205 |
$63.01 |
| 90633 |
|
371 |
349 |
$63.00 |
| 88147 |
|
743 |
677 |
$49.56 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
520 |
494 |
$43.85 |
| 99401 |
|
3,999 |
3,824 |
$38.13 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
468 |
440 |
$37.02 |
| 90674 |
|
406 |
397 |
$36.74 |
| 90647 |
|
202 |
189 |
$36.00 |
| D0603 |
|
75 |
75 |
$36.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
127 |
119 |
$34.69 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
177 |
170 |
$34.30 |
| 85018 |
|
4,118 |
3,961 |
$31.53 |
| 93000 |
|
69 |
65 |
$28.70 |
| 81025 |
|
552 |
489 |
$19.29 |
| 90649 |
|
90 |
90 |
$18.00 |
| 86580 |
|
202 |
196 |
$10.08 |
| 82947 |
|
472 |
463 |
$9.90 |
| 90710 |
|
185 |
176 |
$9.00 |
| 81002 |
|
668 |
610 |
$3.44 |
| 99173 |
|
4,055 |
3,924 |
$2.17 |
| 99383 |
|
140 |
134 |
$0.00 |
| 3075F |
|
56 |
55 |
$0.00 |
| 99384 |
|
72 |
69 |
$0.00 |
| Z1032 |
|
127 |
122 |
$0.00 |
| Z1034 |
|
1,965 |
1,333 |
$0.00 |
| 90696 |
|
44 |
41 |
$0.00 |
| 3074F |
|
371 |
358 |
$0.00 |
| Z6406 |
|
18 |
15 |
$0.00 |
| Z6402 |
|
24 |
24 |
$0.00 |
| 3044F |
|
24 |
24 |
$0.00 |
| 3080F |
|
131 |
121 |
$0.00 |
| 3079F |
|
150 |
146 |
$0.00 |
| 90716 |
|
25 |
24 |
$0.00 |
| 90744 |
|
15 |
15 |
$0.00 |
| Z6404 |
|
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
317 |
306 |
$0.00 |
| 90715 |
|
71 |
71 |
$0.00 |
| 97803 |
|
2,379 |
2,272 |
$0.00 |
| 3078F |
|
436 |
421 |
$0.00 |
| 83037 |
|
789 |
773 |
$0.00 |
| Z6400 |
|
75 |
75 |
$0.00 |
| 90734 |
|
36 |
36 |
$0.00 |
| 3077F |
|
277 |
256 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
27 |
27 |
$0.00 |
| 90670 |
|
132 |
126 |
$0.00 |
| 90700 |
|
24 |
24 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
34 |
30 |
$0.00 |
| Z6302 |
|
12 |
12 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
51 |
47 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
12 |
$0.00 |
| Z6300 |
|
12 |
12 |
$0.00 |
| 99382 |
|
15 |
15 |
$0.00 |
| 90713 |
|
22 |
22 |
$0.00 |
| 90681 |
|
14 |
12 |
$0.00 |