| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
56,620 |
38,622 |
$7.58M |
| D0999 |
Unspecified diagnostic procedure, by report |
6,368 |
5,421 |
$693K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,894 |
904 |
$132K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,841 |
2,820 |
$511.00 |
| 96127 |
|
18,174 |
13,148 |
$417.60 |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,037 |
1,381 |
$195.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
271 |
156 |
$82.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,559 |
11,589 |
$13.00 |
| Q3014 |
Telehealth originating site facility fee |
2,757 |
2,439 |
$12.00 |
| 97802 |
|
7,926 |
6,164 |
$9.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
6,966 |
5,547 |
$8.00 |
| 90647 |
|
1,276 |
1,112 |
$7.40 |
| 90670 |
|
1,727 |
1,502 |
$7.40 |
| 90686 |
|
2,523 |
2,055 |
$4.00 |
| 99173 |
|
3,177 |
2,656 |
$3.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13,331 |
10,647 |
$3.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
7,769 |
6,016 |
$2.77 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,888 |
4,000 |
$2.00 |
| 92551 |
|
2,788 |
2,279 |
$2.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,333 |
1,928 |
$2.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,124 |
1,886 |
$2.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,491 |
1,230 |
$2.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,497 |
1,427 |
$1.00 |
| 90723 |
|
1,342 |
1,175 |
$1.00 |
| 90710 |
|
53 |
50 |
$1.00 |
| 1126F |
|
2,942 |
2,509 |
$0.00 |
| 90696 |
|
40 |
38 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,046 |
1,022 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,838 |
1,787 |
$0.00 |
| 90680 |
|
993 |
868 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,413 |
1,405 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,683 |
1,632 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
578 |
548 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
574 |
$0.00 |
| 90656 |
|
254 |
232 |
$0.00 |
| 3075F |
|
209 |
193 |
$0.00 |
| 90716 |
|
100 |
92 |
$0.00 |
| 3080F |
|
12 |
12 |
$0.00 |
| 3079F |
|
424 |
399 |
$0.00 |
| 90651 |
|
539 |
455 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
37 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
325 |
279 |
$0.00 |
| 90620 |
|
100 |
85 |
$0.00 |
| 1125F |
|
112 |
107 |
$0.00 |
| 0500F |
|
251 |
231 |
$0.00 |
| 93000 |
|
38 |
38 |
$0.00 |
| 90677 |
|
97 |
87 |
$0.00 |
| D2330 |
|
13 |
13 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
359 |
271 |
$0.00 |
| 3074F |
|
1,936 |
1,662 |
$0.00 |
| 99383 |
|
34 |
30 |
$0.00 |
| D1351 |
Sealant - per tooth |
44 |
28 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
156 |
147 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
293 |
189 |
$0.00 |
| 99381 |
|
15 |
13 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
20 |
18 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
24 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,370 |
2,280 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,861 |
1,828 |
$0.00 |
| 81025 |
|
1,050 |
888 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
250 |
232 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
312 |
296 |
$0.00 |
| 0502F |
|
4,763 |
2,784 |
$0.00 |
| 90633 |
|
868 |
730 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
654 |
548 |
$0.00 |
| 81002 |
|
4,682 |
3,121 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
330 |
304 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,201 |
973 |
$0.00 |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$0.00 |
| 90715 |
|
261 |
230 |
$0.00 |
| 92552 |
|
207 |
184 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,741 |
1,488 |
$0.00 |
| 3078F |
|
1,784 |
1,526 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
248 |
235 |
$0.00 |
| 1159F |
|
49 |
37 |
$0.00 |
| 90700 |
|
38 |
26 |
$0.00 |
| 90734 |
|
722 |
628 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
192 |
184 |
$0.00 |
| 90707 |
|
93 |
75 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
34 |
32 |
$0.00 |
| 1160F |
|
49 |
37 |
$0.00 |
| 3077F |
|
50 |
46 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
52 |
51 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
67 |
59 |
$0.00 |