| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,044 |
12,456 |
$3.97M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,707 |
4,131 |
$220K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,285 |
4,304 |
$195K |
| G0490 |
Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only) |
1,026 |
294 |
$52K |
| 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 |
360 |
340 |
$46K |
| 90837 |
Psychotherapy, 53 minutes with patient |
417 |
255 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
553 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
391 |
139 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
153 |
74 |
$10K |
| D1206 |
Topical application of fluoride varnish |
455 |
373 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
85 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
269 |
224 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
147 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
168 |
$6K |
| D1120 |
Prophylaxis - child |
141 |
132 |
$3K |
| D9110 |
|
36 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
159 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$1K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
450 |
413 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
34 |
33 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
55 |
46 |
$691.35 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$662.57 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
50 |
48 |
$321.74 |
| 90686 |
|
42 |
42 |
$297.21 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
27 |
$91.20 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
90 |
88 |
$12.96 |
| D0603 |
|
185 |
133 |
$0.00 |
| D1330 |
|
492 |
369 |
$0.00 |
| D1310 |
|
430 |
319 |
$0.00 |
| D0180 |
|
18 |
17 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |