| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,247 |
14,134 |
$2.01M |
| 99199 |
Unlisted special service, procedure or report |
170,163 |
103,506 |
$927K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,052 |
849 |
$65K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
843 |
747 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
733 |
705 |
$31K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,413 |
1,209 |
$30K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
372 |
324 |
$26K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,168 |
1,884 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,182 |
1,106 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
566 |
502 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,171 |
1,122 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,221 |
557 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
132 |
111 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,369 |
979 |
$9K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
814 |
727 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
311 |
296 |
$8K |
| 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 |
261 |
213 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
68 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
25 |
$4K |
| D0274 |
Bitewings - four radiographic images |
103 |
102 |
$3K |
| D1110 |
Prophylaxis - adult |
83 |
82 |
$3K |
| 0011A |
|
74 |
72 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
78 |
$3K |
| D1120 |
Prophylaxis - child |
95 |
95 |
$3K |
| 0012A |
|
56 |
53 |
$3K |
| 96160 |
|
888 |
746 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| 96161 |
|
732 |
526 |
$787.16 |
| 90620 |
|
13 |
13 |
$330.00 |
| 90734 |
|
41 |
37 |
$257.05 |
| 92551 |
|
1,139 |
966 |
$49.78 |
| 99173 |
|
1,274 |
1,088 |
$28.00 |
| 96127 |
|
111 |
90 |
$23.55 |
| 90723 |
|
336 |
295 |
$0.00 |
| 90645 |
|
599 |
510 |
$0.00 |
| 90680 |
|
415 |
365 |
$0.00 |
| 3008F |
|
71 |
66 |
$0.00 |
| 90651 |
|
63 |
52 |
$0.00 |
| 90716 |
|
75 |
66 |
$0.00 |
| 91301 |
|
165 |
156 |
$0.00 |
| 90677 |
|
17 |
14 |
$0.00 |
| 90633 |
|
275 |
252 |
$0.00 |
| 90707 |
|
49 |
41 |
$0.00 |
| 90670 |
|
825 |
716 |
$0.00 |
| 90700 |
|
140 |
132 |
$0.00 |
| 90649 |
|
17 |
15 |
$0.00 |