| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
51,624 |
36,157 |
$2.94M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
20,036 |
11,290 |
$627K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28,682 |
15,074 |
$614K |
| 90832 |
Psychotherapy, 30 minutes with patient |
7,046 |
2,844 |
$151K |
| D1110 |
Prophylaxis - adult |
5,566 |
3,808 |
$67K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,671 |
2,267 |
$52K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,687 |
833 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,620 |
3,173 |
$42K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,318 |
1,390 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
5,445 |
3,724 |
$36K |
| 90791 |
Psychiatric diagnostic evaluation |
823 |
468 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
856 |
562 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
703 |
360 |
$22K |
| D0330 |
Panoramic radiographic image |
2,432 |
1,809 |
$22K |
| 80305 |
|
3,802 |
2,073 |
$21K |
| 90837 |
Psychotherapy, 53 minutes with patient |
566 |
372 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,856 |
1,222 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,450 |
962 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,334 |
3,150 |
$16K |
| D1120 |
Prophylaxis - child |
1,735 |
1,232 |
$14K |
| 90686 |
|
1,614 |
1,047 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
6,365 |
4,256 |
$13K |
| D1206 |
Topical application of fluoride varnish |
1,292 |
800 |
$11K |
| D0272 |
Bitewings - two radiographic images |
3,853 |
2,799 |
$10K |
| 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 |
1,299 |
1,118 |
$9K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,587 |
1,587 |
$9K |
| 36416 |
|
4,605 |
2,630 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
710 |
331 |
$7K |
| 82962 |
|
4,625 |
2,669 |
$6K |
| 90682 |
|
122 |
96 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
138 |
81 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
220 |
153 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
135 |
75 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
134 |
72 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,024 |
814 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
292 |
165 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
50 |
$2K |
| 90732 |
|
14 |
14 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
32 |
15 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
139 |
101 |
$1K |
| 90715 |
|
49 |
38 |
$1K |
| 92551 |
|
255 |
143 |
$893.72 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
25 |
14 |
$749.10 |
| 85018 |
|
615 |
334 |
$591.86 |
| 90662 |
|
14 |
14 |
$439.98 |
| 97803 |
|
24 |
24 |
$421.33 |
| 90688 |
|
38 |
16 |
$393.92 |
| 99173 |
|
306 |
170 |
$386.62 |
| 93000 |
|
47 |
38 |
$362.60 |
| G0008 |
Administration of influenza virus vaccine |
46 |
43 |
$238.19 |
| 90656 |
|
26 |
26 |
$220.00 |
| D1351 |
Sealant - per tooth |
24 |
14 |
$176.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
22 |
17 |
$138.76 |
| 81025 |
|
20 |
12 |
$116.28 |
| 81000 |
|
87 |
36 |
$75.50 |
| 81002 |
|
21 |
12 |
$26.98 |
| 3044F |
|
479 |
451 |
$20.00 |
| 90672 |
|
33 |
25 |
$10.08 |
| 90461 |
|
60 |
41 |
$0.29 |
| 90633 |
|
16 |
13 |
$0.01 |
| 4004F |
|
2,498 |
2,192 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
11,826 |
10,072 |
$0.00 |
| 3078F |
|
9,138 |
8,049 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
1,614 |
1,458 |
$0.00 |
| 1159F |
|
773 |
733 |
$0.00 |
| 3050F |
|
409 |
351 |
$0.00 |
| 3077F |
|
1,760 |
1,596 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
19 |
18 |
$0.00 |
| 1036F |
|
9,968 |
8,639 |
$0.00 |
| 3079F |
|
5,560 |
4,959 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
12,577 |
10,644 |
$0.00 |
| 3074F |
|
10,498 |
9,136 |
$0.00 |
| 2001F |
|
17,764 |
15,071 |
$0.00 |
| 3008F |
|
17,756 |
15,068 |
$0.00 |
| 3080F |
|
734 |
670 |
$0.00 |
| 3048F |
|
2,629 |
2,212 |
$0.00 |
| 1111F |
|
7,123 |
6,067 |
$0.00 |
| 3075F |
|
3,261 |
2,998 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
941 |
857 |
$0.00 |
| 3049F |
|
1,309 |
1,104 |
$0.00 |
| 1034F |
|
3,990 |
3,430 |
$0.00 |
| 1126F |
|
349 |
341 |
$0.00 |
| 86580 |
|
12 |
12 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
30 |
28 |
$0.00 |
| 1125F |
|
209 |
201 |
$0.00 |