| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
34,067 |
27,496 |
$4.58M |
| D9450 |
|
36,912 |
21,530 |
$1.26M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,478 |
1,980 |
$732K |
| 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 |
10,819 |
8,667 |
$468K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
2,833 |
1,445 |
$392K |
| D1110 |
Prophylaxis - adult |
8,172 |
5,540 |
$265K |
| D0140 |
Limited oral evaluation - problem focused |
7,354 |
4,437 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,554 |
1,494 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
2,796 |
1,775 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,478 |
1,339 |
$104K |
| D0274 |
Bitewings - four radiographic images |
4,127 |
3,025 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
6,668 |
4,597 |
$95K |
| D0330 |
Panoramic radiographic image |
2,734 |
1,752 |
$95K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
660 |
659 |
$91K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
693 |
691 |
$85K |
| D9110 |
|
2,655 |
1,853 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
6,792 |
4,314 |
$63K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
298 |
297 |
$45K |
| D1120 |
Prophylaxis - child |
865 |
860 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,813 |
1,775 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
975 |
307 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,745 |
1,079 |
$38K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
923 |
785 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
721 |
346 |
$29K |
| D2331 |
|
618 |
248 |
$29K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
152 |
129 |
$27K |
| 90834 |
Psychotherapy, 45 minutes with patient |
289 |
158 |
$26K |
| D2330 |
|
700 |
247 |
$24K |
| D1351 |
Sealant - per tooth |
390 |
116 |
$14K |
| 0011A |
|
425 |
424 |
$14K |
| 91322 |
|
93 |
93 |
$14K |
| 0012A |
|
239 |
238 |
$12K |
| 80305 |
|
1,341 |
982 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,277 |
1,206 |
$12K |
| D4342 |
|
232 |
54 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,376 |
3,773 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,630 |
739 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
942 |
918 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
122 |
122 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,308 |
1,296 |
$10K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
195 |
194 |
$10K |
| 99173 |
|
848 |
844 |
$9K |
| 90686 |
|
911 |
906 |
$9K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
97 |
95 |
$8K |
| D0180 |
|
281 |
254 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,795 |
4,340 |
$7K |
| 92551 |
|
649 |
646 |
$6K |
| 90480 |
|
123 |
123 |
$6K |
| 96127 |
|
1,066 |
1,037 |
$5K |
| D2394 |
|
79 |
38 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
399 |
342 |
$4K |
| 90677 |
|
42 |
42 |
$4K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
222 |
178 |
$3K |
| 90715 |
|
131 |
130 |
$3K |
| D2335 |
|
36 |
12 |
$2K |
| 0124A |
|
60 |
60 |
$2K |
| D2332 |
|
40 |
13 |
$2K |
| 99188 |
|
64 |
64 |
$2K |
| 0002A |
|
41 |
41 |
$2K |
| 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 |
273 |
214 |
$1K |
| 90461 |
|
270 |
265 |
$1K |
| 0031A |
|
32 |
32 |
$1K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
14 |
12 |
$1K |
| 0071A |
|
24 |
24 |
$917.40 |
| 90832 |
Psychotherapy, 30 minutes with patient |
21 |
12 |
$905.94 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
45 |
31 |
$878.46 |
| 0001A |
|
27 |
27 |
$825.66 |
| 87634 |
|
13 |
12 |
$804.96 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
26 |
25 |
$804.70 |
| D0272 |
Bitewings - two radiographic images |
37 |
29 |
$746.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
60 |
60 |
$669.85 |
| 0072A |
|
17 |
17 |
$642.18 |
| D0270 |
|
81 |
43 |
$528.00 |
| D9310 |
|
333 |
247 |
$279.00 |
| 81003 |
|
135 |
129 |
$255.42 |
| 81025 |
|
36 |
36 |
$224.64 |
| 87400 |
|
18 |
17 |
$224.28 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
16 |
16 |
$148.51 |
| 81002 |
|
56 |
55 |
$100.15 |
| 99215 |
Prolong outpt/office vis |
132 |
124 |
$77.43 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
53 |
38 |
$0.00 |
| 91312 |
|
111 |
109 |
$0.00 |
| 91300 |
|
115 |
113 |
$0.00 |
| D9996 |
|
44 |
29 |
$0.00 |
| D0190 |
|
16 |
16 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
31 |
13 |
$0.00 |
| 99051 |
|
16 |
16 |
$0.00 |
| 91301 |
|
648 |
638 |
$0.00 |
| 91305 |
|
116 |
114 |
$0.00 |
| D0171 |
|
56 |
37 |
$0.00 |
| D1330 |
|
101 |
72 |
$0.00 |
| 99406 |
|
54 |
50 |
$0.00 |
| 99000 |
|
36 |
32 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 91307 |
|
37 |
36 |
$0.00 |
| 91303 |
|
30 |
30 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
16 |
16 |
$0.00 |