| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
38,142 |
26,927 |
$6.35M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,528 |
13,764 |
$329K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,363 |
3,974 |
$155K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,670 |
3,243 |
$69K |
| 90832 |
Psychotherapy, 30 minutes with patient |
417 |
196 |
$47K |
| 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 |
793 |
591 |
$26K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,896 |
1,722 |
$25K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,654 |
1,557 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
943 |
910 |
$13K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
829 |
772 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,358 |
4,146 |
$7K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,378 |
2,257 |
$4K |
| 59025 |
Fetal non-stress test |
286 |
104 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
459 |
291 |
$2K |
| 99000 |
|
63 |
62 |
$681.52 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
25 |
25 |
$643.68 |
| D0140 |
Limited oral evaluation - problem focused |
721 |
676 |
$623.38 |
| D1206 |
Topical application of fluoride varnish |
1,179 |
1,140 |
$541.56 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
332 |
305 |
$509.55 |
| 96160 |
|
297 |
295 |
$314.96 |
| D1120 |
Prophylaxis - child |
519 |
505 |
$314.36 |
| 90715 |
|
162 |
156 |
$313.80 |
| D1110 |
Prophylaxis - adult |
547 |
513 |
$312.02 |
| D0274 |
Bitewings - four radiographic images |
296 |
283 |
$312.02 |
| D0120 |
Periodic oral evaluation - established patient |
354 |
338 |
$247.85 |
| 90756 |
|
106 |
104 |
$240.73 |
| 90474 |
|
560 |
537 |
$227.04 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
387 |
$158.35 |
| D0220 |
Intraoral - periapical first radiographic image |
753 |
705 |
$156.01 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
244 |
177 |
$86.07 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
222 |
$69.28 |
| 81002 |
|
412 |
385 |
$43.27 |
| 81025 |
|
235 |
223 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
50 |
50 |
$0.00 |
| 90671 |
|
113 |
75 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
212 |
152 |
$0.00 |
| 90670 |
|
122 |
120 |
$0.00 |
| 90633 |
|
48 |
38 |
$0.00 |
| 94150 |
|
15 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,325 |
225 |
$0.00 |
| 90697 |
|
300 |
268 |
$0.00 |
| 90680 |
|
74 |
74 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
17 |
14 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
49 |
$0.00 |
| 90677 |
|
201 |
201 |
$0.00 |
| 85018 |
|
385 |
351 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
145 |
91 |
$0.00 |
| 36416 |
|
206 |
195 |
$0.00 |
| 94760 |
|
82 |
72 |
$0.00 |
| 90686 |
|
103 |
103 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
86 |
83 |
$0.00 |
| 90656 |
|
43 |
43 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
16 |
15 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
16 |
15 |
$0.00 |