| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
17,588 |
14,549 |
$2.58M |
| D9450 |
|
15,210 |
8,747 |
$551K |
| D1110 |
Prophylaxis - adult |
5,658 |
3,739 |
$186K |
| 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 |
6,028 |
5,055 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
5,444 |
3,702 |
$77K |
| 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 |
1,996 |
914 |
$70K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,292 |
1,837 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,070 |
1,408 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,194 |
652 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,030 |
614 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,891 |
5,488 |
$23K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,517 |
6,711 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
450 |
119 |
$17K |
| D1206 |
Topical application of fluoride varnish |
618 |
593 |
$15K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
109 |
109 |
$14K |
| D1120 |
Prophylaxis - child |
286 |
275 |
$13K |
| 92015 |
Determination of refractive state |
1,475 |
1,469 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,267 |
870 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
149 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
165 |
$11K |
| 97803 |
|
818 |
727 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
102 |
39 |
$8K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
80 |
48 |
$7K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
386 |
295 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
85 |
85 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
587 |
582 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,560 |
1,541 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
230 |
103 |
$4K |
| 90756 |
|
280 |
278 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$3K |
| 92552 |
|
126 |
120 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
24 |
$2K |
| 99173 |
|
183 |
181 |
$2K |
| 90686 |
|
285 |
285 |
$2K |
| 92341 |
|
38 |
36 |
$1K |
| 87430 |
|
152 |
146 |
$1K |
| D2331 |
|
29 |
12 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
822 |
807 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$1K |
| D9110 |
|
55 |
37 |
$1K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
30 |
30 |
$1K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
56 |
49 |
$969.66 |
| 90674 |
|
28 |
28 |
$884.12 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
198 |
187 |
$711.40 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
46 |
45 |
$639.03 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$435.00 |
| 0124A |
|
14 |
13 |
$321.09 |
| 0011A |
|
111 |
111 |
$271.04 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
89 |
89 |
$238.41 |
| 0064A |
|
76 |
76 |
$229.35 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
27 |
27 |
$210.58 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$162.10 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
80 |
78 |
$46.58 |
| 90656 |
|
141 |
140 |
$30.00 |
| 0072A |
|
16 |
16 |
$22.87 |
| D1999 |
|
2,026 |
977 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
15 |
14 |
$0.00 |
| 0003A |
|
13 |
13 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,708 |
803 |
$0.00 |
| 94760 |
|
3,661 |
3,342 |
$0.00 |
| 0012A |
|
110 |
110 |
$0.00 |
| D9995 |
|
134 |
61 |
$0.00 |
| 0031A |
|
22 |
22 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
16 |
16 |
$0.00 |