| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,591 |
22,263 |
$2.42M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,562 |
14,718 |
$533K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,526 |
1,533 |
$61K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,235 |
1,154 |
$55K |
| 90791 |
Psychiatric diagnostic evaluation |
1,030 |
511 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,500 |
582 |
$30K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,257 |
536 |
$24K |
| D0330 |
Panoramic radiographic image |
1,682 |
984 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,510 |
1,550 |
$15K |
| 99051 |
|
1,396 |
750 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,193 |
614 |
$14K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,172 |
337 |
$11K |
| D1110 |
Prophylaxis - adult |
1,031 |
646 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
1,628 |
924 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
203 |
$8K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
470 |
237 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
188 |
$6K |
| 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 |
657 |
478 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
96 |
52 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,043 |
1,098 |
$3K |
| 90674 |
|
300 |
141 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
554 |
310 |
$3K |
| D1120 |
Prophylaxis - child |
378 |
199 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,076 |
754 |
$2K |
| 90661 |
|
112 |
105 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,443 |
444 |
$1K |
| D1351 |
Sealant - per tooth |
110 |
12 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
140 |
84 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
55 |
$675.68 |
| 0012A |
|
18 |
18 |
$609.96 |
| 90670 |
|
23 |
12 |
$528.95 |
| D0120 |
Periodic oral evaluation - established patient |
74 |
36 |
$495.32 |
| D0272 |
Bitewings - two radiographic images |
145 |
70 |
$480.00 |
| 92551 |
|
134 |
75 |
$446.76 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
72 |
56 |
$274.43 |
| 0011A |
|
18 |
14 |
$272.36 |
| D1206 |
Topical application of fluoride varnish |
28 |
17 |
$165.00 |
| 99173 |
|
155 |
87 |
$145.97 |
| 36415 |
Collection of venous blood by venipuncture |
53 |
27 |
$52.48 |
| 90647 |
|
23 |
12 |
$31.59 |
| 82962 |
|
24 |
12 |
$20.04 |
| 91301 |
|
41 |
38 |
$0.18 |
| 3008F |
|
27,212 |
14,850 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
2,937 |
1,548 |
$0.00 |
| 3075F |
|
3,109 |
1,674 |
$0.00 |
| 3079F |
|
8,375 |
4,577 |
$0.00 |
| 3074F |
|
15,901 |
8,665 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
19,067 |
10,053 |
$0.00 |
| 3080F |
|
2,810 |
1,489 |
$0.00 |
| 2001F |
|
27,253 |
14,858 |
$0.00 |
| 1036F |
|
11,909 |
6,609 |
$0.00 |
| 3077F |
|
4,326 |
2,354 |
$0.00 |
| 3078F |
|
12,298 |
6,808 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
18,145 |
9,538 |
$0.00 |
| 4004F |
|
1,346 |
885 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
3,706 |
1,975 |
$0.00 |
| 1159F |
|
162 |
89 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |