| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H0002 |
Behavioral health screening to determine eligibility for admission to treatment program |
21,707 |
11,658 |
$3.21M |
| D0999 |
Unspecified diagnostic procedure, by report |
5,291 |
4,843 |
$1.11M |
| H0023 |
Behavioral health outreach service (planned approach to reach a targeted population) |
1,743 |
846 |
$270K |
| H0031 |
Mental health assessment, by non-physician |
1,910 |
992 |
$244K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,007 |
1,301 |
$155K |
| 90832 |
Psychotherapy, 30 minutes with patient |
888 |
428 |
$105K |
| 90834 |
Psychotherapy, 45 minutes with patient |
681 |
326 |
$100K |
| D1206 |
Topical application of fluoride varnish |
2,167 |
2,086 |
$83K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
8,373 |
6,472 |
$60K |
| 0012A |
|
1,052 |
940 |
$35K |
| 0001A |
|
928 |
812 |
$30K |
| 0002A |
|
758 |
705 |
$26K |
| 0011A |
|
978 |
918 |
$25K |
| H0001 |
Alcohol and/or drug assessment |
130 |
53 |
$22K |
| 0071A |
|
610 |
533 |
$20K |
| D1351 |
Sealant - per tooth |
361 |
121 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
149 |
141 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
179 |
$15K |
| H0025 |
Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior) |
88 |
43 |
$15K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
200 |
182 |
$14K |
| 0072A |
|
343 |
282 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
325 |
319 |
$9K |
| D1120 |
Prophylaxis - child |
158 |
155 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
37 |
37 |
$9K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
364 |
326 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
145 |
133 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
228 |
211 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
24 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
142 |
139 |
$6K |
| 0064A |
|
159 |
157 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
201 |
169 |
$5K |
| T1017 |
Targeted case management, each 15 minutes |
28 |
26 |
$4K |
| 0004A |
|
145 |
140 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
165 |
162 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
17 |
$3K |
| D1110 |
Prophylaxis - adult |
37 |
36 |
$3K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$2K |
| D4910 |
|
13 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
28 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$897.00 |
| 0031A |
|
20 |
18 |
$658.88 |
| 91307 |
|
801 |
704 |
$225.15 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
33 |
31 |
$114.14 |
| 99201 |
|
17 |
14 |
$78.16 |
| D0190 |
|
1,142 |
1,090 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
128 |
67 |
$0.00 |
| 91300 |
|
2,209 |
1,910 |
$0.00 |
| 90715 |
|
17 |
17 |
$0.00 |
| 81002 |
|
13 |
12 |
$0.00 |
| 90713 |
|
41 |
41 |
$0.00 |
| 90746 |
|
12 |
12 |
$0.00 |
| 91301 |
|
2,174 |
1,978 |
$0.00 |
| 91303 |
|
20 |
18 |
$0.00 |
| 90686 |
|
177 |
163 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
14 |
$0.00 |
| 91306 |
|
141 |
139 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
50 |
24 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
52 |
25 |
$0.00 |
| 90716 |
|
14 |
14 |
$0.00 |
| 90656 |
|
42 |
42 |
$0.00 |
| 99000 |
|
30 |
14 |
$0.00 |