| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
95,781 |
77,559 |
$27.38M |
| G9012 |
Other specified case management service not elsewhere classified |
3,574 |
3,502 |
$966K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,437 |
974 |
$69K |
| V2020 |
Frames, purchases |
1,484 |
1,181 |
$46K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,978 |
22,197 |
$14K |
| 0011A |
|
263 |
263 |
$10K |
| 0012A |
|
226 |
226 |
$9K |
| 3079F |
|
7,272 |
6,688 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,546 |
4,281 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,491 |
5,110 |
$3K |
| 3074F |
|
14,732 |
13,311 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
279 |
274 |
$3K |
| 3077F |
|
2,213 |
2,023 |
$2K |
| 3078F |
|
11,144 |
10,146 |
$2K |
| 3075F |
|
2,825 |
2,678 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,444 |
547 |
$2K |
| 0064A |
|
38 |
38 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
389 |
382 |
$1K |
| 3080F |
|
1,157 |
1,053 |
$1K |
| 92551 |
|
3,081 |
3,015 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
726 |
716 |
$1K |
| 0071A |
|
24 |
23 |
$880.00 |
| 99173 |
|
3,346 |
3,278 |
$829.78 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
180 |
177 |
$754.15 |
| 0072A |
|
18 |
18 |
$720.00 |
| 90656 |
|
208 |
203 |
$717.74 |
| 0002A |
|
17 |
17 |
$680.00 |
| 0001A |
|
14 |
14 |
$520.00 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
5,681 |
2,395 |
$470.68 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
4,141 |
1,852 |
$438.41 |
| 80305 |
|
4,423 |
3,593 |
$390.95 |
| 36415 |
Collection of venous blood by venipuncture |
2,327 |
2,256 |
$331.09 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
969 |
953 |
$290.22 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
635 |
613 |
$215.80 |
| 3008F |
|
9,896 |
8,933 |
$164.72 |
| 90715 |
|
27 |
27 |
$114.01 |
| D0120 |
Periodic oral evaluation - established patient |
4,195 |
4,166 |
$100.00 |
| 97024 |
|
1,883 |
835 |
$84.12 |
| 90688 |
|
524 |
522 |
$82.72 |
| D1110 |
Prophylaxis - adult |
3,896 |
3,851 |
$81.60 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
737 |
722 |
$80.00 |
| D2335 |
|
197 |
174 |
$72.00 |
| 3044F |
|
12 |
12 |
$60.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
994 |
968 |
$55.50 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
788 |
652 |
$54.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,521 |
996 |
$54.00 |
| 83655 |
|
91 |
91 |
$50.00 |
| 90633 |
|
104 |
102 |
$35.13 |
| D9110 |
|
3,213 |
3,028 |
$30.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
411 |
377 |
$27.94 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
291 |
280 |
$22.00 |
| D1206 |
Topical application of fluoride varnish |
3,208 |
3,183 |
$20.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
77 |
67 |
$19.89 |
| D0220 |
Intraoral - periapical first radiographic image |
2,614 |
2,554 |
$17.60 |
| 82962 |
|
1,180 |
1,124 |
$17.60 |
| 81025 |
|
1,574 |
1,314 |
$16.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
671 |
658 |
$15.40 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
143 |
133 |
$14.36 |
| D1330 |
|
4,977 |
4,941 |
$10.00 |
| 1159F |
|
9,139 |
7,922 |
$0.00 |
| 99499 |
|
16 |
15 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,576 |
1,558 |
$0.00 |
| D0330 |
Panoramic radiographic image |
289 |
288 |
$0.00 |
| 90461 |
|
1,537 |
1,498 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
89 |
83 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,965 |
1,951 |
$0.00 |
| 90670 |
|
456 |
450 |
$0.00 |
| 92015 |
Determination of refractive state |
242 |
240 |
$0.00 |
| 3050F |
|
17 |
16 |
$0.00 |
| D2332 |
|
210 |
177 |
$0.00 |
| D2140 |
|
204 |
178 |
$0.00 |
| 91300 |
|
14 |
13 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
637 |
534 |
$0.00 |
| 96160 |
|
274 |
270 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
33 |
32 |
$0.00 |
| 0502F |
|
147 |
128 |
$0.00 |
| G9920 |
Screening performed and negative |
13 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
78 |
77 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
39 |
39 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
14 |
14 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
29 |
$0.00 |
| 90756 |
|
15 |
15 |
$0.00 |
| D0191 |
|
14 |
14 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
31 |
30 |
$0.00 |
| 1160F |
|
35 |
35 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$0.00 |
| 90734 |
|
13 |
13 |
$0.00 |
| 90746 |
|
13 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
927 |
238 |
$0.00 |
| 2001F |
|
6,469 |
5,722 |
$0.00 |
| D2331 |
|
269 |
234 |
$0.00 |
| 96161 |
|
27 |
26 |
$0.00 |
| 90677 |
|
80 |
80 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
959 |
953 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,826 |
1,811 |
$0.00 |
| 1036F |
|
13,867 |
12,292 |
$0.00 |
| 90686 |
|
603 |
595 |
$0.00 |
| 3048F |
|
336 |
299 |
$0.00 |
| D5899 |
|
684 |
593 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
949 |
$0.00 |
| D0603 |
|
1,790 |
1,774 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,031 |
$0.00 |
| 96127 |
|
120 |
116 |
$0.00 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
468 |
232 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
254 |
$0.00 |
| 0501F |
|
175 |
150 |
$0.00 |
| 99383 |
|
12 |
12 |
$0.00 |
| 97026 |
|
638 |
308 |
$0.00 |
| D2330 |
|
164 |
134 |
$0.00 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
203 |
71 |
$0.00 |
| 90698 |
|
372 |
368 |
$0.00 |
| 97162 |
|
52 |
52 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
328 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
67 |
66 |
$0.00 |
| 91301 |
|
99 |
98 |
$0.00 |
| D2160 |
|
140 |
134 |
$0.00 |
| 88142 |
|
30 |
30 |
$0.00 |
| 90744 |
|
36 |
36 |
$0.00 |
| 85018 |
|
13 |
13 |
$0.00 |
| 90651 |
|
86 |
86 |
$0.00 |
| 90619 |
|
28 |
28 |
$0.00 |
| 3049F |
|
61 |
54 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
13 |
12 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |