| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
43,725 |
33,434 |
$5.97M |
| D0999 |
Unspecified diagnostic procedure, by report |
9,369 |
5,787 |
$829K |
| H2020 |
Therapeutic behavioral services, per diem |
3,508 |
2,553 |
$442K |
| 99051 |
|
2,289 |
1,800 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,780 |
1,275 |
$15K |
| D0330 |
Panoramic radiographic image |
2,507 |
1,706 |
$9K |
| D1110 |
Prophylaxis - adult |
2,278 |
1,476 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,314 |
1,498 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
505 |
294 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
1,263 |
888 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
648 |
463 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,574 |
961 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,979 |
16,375 |
$1K |
| 3074F |
|
15,871 |
12,771 |
$910.02 |
| 3079F |
|
9,404 |
7,673 |
$814.89 |
| 3078F |
|
13,496 |
10,946 |
$640.02 |
| D0274 |
Bitewings - four radiographic images |
2,566 |
1,643 |
$557.60 |
| 3077F |
|
3,443 |
2,771 |
$460.00 |
| 96160 |
|
29,001 |
23,156 |
$331.00 |
| 3075F |
|
4,505 |
3,754 |
$204.88 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
4,575 |
2,045 |
$110.00 |
| 96127 |
|
1,145 |
915 |
$71.84 |
| 3080F |
|
616 |
505 |
$70.00 |
| 92551 |
|
1,135 |
935 |
$51.00 |
| 81003 |
|
4,203 |
3,457 |
$49.01 |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
102 |
$39.54 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,107 |
822 |
$28.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
38 |
$24.84 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,338 |
1,141 |
$22.00 |
| 3008F |
|
1,503 |
1,327 |
$0.01 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
1,974 |
1,708 |
$0.00 |
| 1159F |
|
12,673 |
10,004 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
923 |
830 |
$0.00 |
| 1160F |
|
13,975 |
11,061 |
$0.00 |
| 99173 |
|
1,221 |
990 |
$0.00 |
| 80305 |
|
3,324 |
2,685 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
154 |
131 |
$0.00 |
| 90685 |
|
122 |
112 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
262 |
220 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
558 |
474 |
$0.00 |
| 82947 |
|
532 |
405 |
$0.00 |
| G8477 |
Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg |
49 |
39 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
742 |
644 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,585 |
1,250 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
435 |
356 |
$0.00 |
| 83655 |
|
29 |
25 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
305 |
240 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
1,215 |
809 |
$0.00 |
| 90670 |
|
826 |
722 |
$0.00 |
| D1120 |
Prophylaxis - child |
40 |
40 |
$0.00 |
| 90461 |
|
632 |
547 |
$0.00 |
| 90710 |
|
146 |
132 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
58 |
49 |
$0.00 |
| 90633 |
|
161 |
154 |
$0.00 |
| 90671 |
|
27 |
24 |
$0.00 |
| G8476 |
Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
361 |
278 |
$0.00 |
| 81025 |
|
313 |
263 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
168 |
129 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
55 |
47 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
107 |
92 |
$0.00 |
| 90715 |
|
23 |
14 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
13 |
12 |
$0.00 |
| 90661 |
|
37 |
30 |
$0.00 |
| 1158F |
|
89 |
59 |
$0.00 |
| 90473 |
|
12 |
12 |
$0.00 |
| 90734 |
|
45 |
35 |
$0.00 |
| 90756 |
|
23 |
23 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
15 |
12 |
$0.00 |
| G8404 |
Lower extremity neurological exam performed and documented |
15 |
12 |
$0.00 |
| 90648 |
|
17 |
13 |
$0.00 |
| 99177 |
|
16 |
12 |
$0.00 |
| 00000 |
|
347 |
308 |
$0.00 |
| 85018 |
|
1,310 |
1,147 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12,627 |
10,409 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
167 |
137 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,508 |
2,135 |
$0.00 |
| 90680 |
|
473 |
410 |
$0.00 |
| 90744 |
|
321 |
276 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
45 |
$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 |
1,696 |
1,516 |
$0.00 |
| 1126F |
|
10,674 |
8,658 |
$0.00 |
| 3044F |
|
536 |
456 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
239 |
187 |
$0.00 |
| 1125F |
|
4,166 |
3,267 |
$0.00 |
| 3061F |
|
492 |
413 |
$0.00 |
| 3011F |
|
376 |
322 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
730 |
561 |
$0.00 |
| 87807 |
|
220 |
189 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
340 |
263 |
$0.00 |
| 90686 |
|
328 |
292 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
218 |
184 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
34 |
27 |
$0.00 |
| 97802 |
|
687 |
578 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
339 |
277 |
$0.00 |
| 90698 |
|
456 |
403 |
$0.00 |
| 90697 |
|
43 |
37 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
237 |
185 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,257 |
1,065 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
3,144 |
2,291 |
$0.00 |
| 99406 |
|
221 |
140 |
$0.00 |
| 91301 |
|
60 |
25 |
$0.00 |
| 99381 |
|
105 |
82 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
378 |
285 |
$0.00 |
| 96161 |
|
479 |
376 |
$0.00 |
| 82043 |
|
968 |
807 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
466 |
402 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
92 |
72 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
173 |
119 |
$0.00 |
| 1170F |
|
94 |
65 |
$0.00 |
| 90677 |
|
81 |
77 |
$0.00 |
| 90651 |
|
87 |
63 |
$0.00 |
| 90674 |
|
17 |
14 |
$0.00 |
| 36416 |
|
14 |
14 |
$0.00 |
| 0012A |
|
40 |
15 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
14 |
13 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
15 |
12 |
$0.00 |
| 0011A |
|
20 |
12 |
$0.00 |
| 99383 |
|
18 |
14 |
$0.00 |
| 90620 |
|
16 |
12 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
16 |
13 |
$0.00 |