| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
42,703 |
32,278 |
$2.99M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,929 |
14,239 |
$377K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,236 |
5,249 |
$220K |
| 90837 |
Psychotherapy, 53 minutes with patient |
4,024 |
1,234 |
$161K |
| 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 |
4,027 |
2,828 |
$46K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,370 |
624 |
$37K |
| D0330 |
Panoramic radiographic image |
3,804 |
3,052 |
$36K |
| D1110 |
Prophylaxis - adult |
3,873 |
3,127 |
$26K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,021 |
1,190 |
$22K |
| 90832 |
Psychotherapy, 30 minutes with patient |
916 |
383 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
5,446 |
4,277 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,860 |
3,140 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,479 |
776 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
220 |
$11K |
| 90791 |
Psychiatric diagnostic evaluation |
209 |
122 |
$10K |
| D1120 |
Prophylaxis - child |
1,787 |
1,418 |
$8K |
| D1206 |
Topical application of fluoride varnish |
2,017 |
1,629 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,307 |
1,052 |
$6K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
307 |
247 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
50 |
$2K |
| 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 |
112 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,536 |
1,257 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
49 |
36 |
$1K |
| 90674 |
|
320 |
240 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
100 |
56 |
$636.18 |
| 90686 |
|
80 |
49 |
$391.59 |
| 80305 |
|
61 |
41 |
$253.02 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
18 |
13 |
$194.65 |
| 90756 |
|
56 |
30 |
$105.13 |
| 90715 |
|
27 |
15 |
$33.64 |
| 3074F |
|
8,191 |
4,672 |
$0.59 |
| 3079F |
|
4,145 |
2,433 |
$0.41 |
| 3078F |
|
6,361 |
3,611 |
$0.37 |
| 3077F |
|
2,292 |
1,295 |
$0.29 |
| 3080F |
|
1,180 |
634 |
$0.21 |
| 3075F |
|
1,051 |
599 |
$0.18 |
| 4004F |
|
4,567 |
2,473 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
88 |
$0.00 |
| D2140 |
|
175 |
130 |
$0.00 |
| 81002 |
|
77 |
73 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
50 |
44 |
$0.00 |
| 3725F |
|
252 |
162 |
$0.00 |
| 1036F |
|
4,802 |
2,654 |
$0.00 |
| 3008F |
|
13,063 |
7,283 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
13 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
43 |
40 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
49 |
43 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| 87430 |
|
13 |
13 |
$0.00 |