| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
34,543 |
30,325 |
$5.33M |
| D9450 |
|
44,898 |
30,265 |
$1.03M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,413 |
2,368 |
$358K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,427 |
2,421 |
$352K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,868 |
5,780 |
$293K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,570 |
1,565 |
$264K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,739 |
1,733 |
$251K |
| D1110 |
Prophylaxis - adult |
14,485 |
11,634 |
$193K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,263 |
1,259 |
$178K |
| D9110 |
|
7,083 |
3,637 |
$172K |
| D1120 |
Prophylaxis - child |
2,552 |
2,460 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
13,873 |
7,660 |
$125K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,109 |
3,705 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
12,206 |
10,079 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,206 |
2,988 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,946 |
2,972 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
4,566 |
3,625 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,600 |
4,864 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,893 |
2,744 |
$72K |
| 92015 |
Determination of refractive state |
5,217 |
5,212 |
$63K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,464 |
1,437 |
$62K |
| D0274 |
Bitewings - four radiographic images |
5,584 |
4,587 |
$61K |
| 99050 |
|
1,171 |
1,141 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,776 |
2,283 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,321 |
508 |
$56K |
| 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 |
1,547 |
1,317 |
$47K |
| 90686 |
|
3,102 |
3,085 |
$42K |
| 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 |
1,018 |
502 |
$36K |
| 90746 |
|
549 |
546 |
$34K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,120 |
7,043 |
$34K |
| 90677 |
|
395 |
394 |
$32K |
| 91320 |
|
286 |
286 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,313 |
738 |
$30K |
| 90750 |
|
467 |
464 |
$26K |
| 99381 |
|
116 |
116 |
$25K |
| 0012A |
|
444 |
444 |
$21K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,109 |
1,986 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,059 |
934 |
$20K |
| 0011A |
|
400 |
399 |
$17K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
777 |
346 |
$17K |
| 99402 |
|
284 |
279 |
$17K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
129 |
127 |
$16K |
| 90480 |
|
356 |
356 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
213 |
97 |
$16K |
| 90715 |
|
629 |
625 |
$15K |
| D2331 |
|
938 |
652 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
839 |
646 |
$14K |
| 99173 |
|
968 |
965 |
$14K |
| 81025 |
|
1,783 |
1,742 |
$12K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,910 |
2,894 |
$12K |
| D2330 |
|
762 |
371 |
$11K |
| 99188 |
|
392 |
388 |
$10K |
| 0124A |
|
228 |
223 |
$9K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,336 |
1,322 |
$9K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
59 |
55 |
$8K |
| 96127 |
|
737 |
719 |
$7K |
| 92341 |
|
206 |
204 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
925 |
466 |
$6K |
| D0330 |
Panoramic radiographic image |
133 |
75 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,260 |
2,243 |
$5K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
76 |
76 |
$5K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
387 |
384 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
68 |
68 |
$5K |
| 92551 |
|
458 |
455 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
406 |
386 |
$4K |
| 81000 |
|
1,214 |
1,195 |
$4K |
| 90670 |
|
189 |
189 |
$4K |
| 90651 |
|
362 |
359 |
$3K |
| 99383 |
|
17 |
17 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
72 |
$3K |
| D1354 |
|
289 |
136 |
$3K |
| 85018 |
|
1,203 |
1,189 |
$3K |
| D0272 |
Bitewings - two radiographic images |
93 |
92 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
16 |
$2K |
| D0180 |
|
327 |
295 |
$2K |
| D2332 |
|
58 |
37 |
$2K |
| 99385 |
|
13 |
13 |
$2K |
| D0270 |
|
522 |
418 |
$2K |
| D4341 |
|
106 |
37 |
$2K |
| 90707 |
|
86 |
86 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
24 |
24 |
$1K |
| 82947 |
|
257 |
234 |
$1K |
| D2140 |
|
48 |
29 |
$906.00 |
| D2335 |
|
58 |
41 |
$710.00 |
| 90716 |
|
108 |
107 |
$641.27 |
| 90832 |
Psychotherapy, 30 minutes with patient |
19 |
14 |
$585.35 |
| 90461 |
|
1,195 |
1,191 |
$186.96 |
| 81003 |
|
83 |
81 |
$162.36 |
| 82274 |
|
12 |
12 |
$153.93 |
| 90694 |
|
15 |
15 |
$147.35 |
| 99442 |
|
12 |
12 |
$145.67 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$122.43 |
| 90474 |
|
269 |
267 |
$44.15 |
| 36415 |
Collection of venous blood by venipuncture |
811 |
792 |
$6.00 |
| 90633 |
|
385 |
383 |
$0.00 |
| 90648 |
|
179 |
178 |
$0.00 |
| 91312 |
|
144 |
142 |
$0.00 |
| 90710 |
|
38 |
38 |
$0.00 |
| 90680 |
|
386 |
385 |
$0.00 |
| 90697 |
|
239 |
238 |
$0.00 |
| 90619 |
|
155 |
155 |
$0.00 |
| 36416 |
|
413 |
406 |
$0.00 |
| 91301 |
|
949 |
938 |
$0.00 |
| 90723 |
|
118 |
118 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
30 |
27 |
$0.00 |
| 90688 |
|
19 |
19 |
$0.00 |
| 91307 |
|
14 |
13 |
$0.00 |