| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
117,800 |
71,331 |
$15.64M |
| D0999 |
Unspecified diagnostic procedure, by report |
11,235 |
7,463 |
$1.12M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,777 |
961 |
$121K |
| 0011A |
|
720 |
662 |
$22K |
| 0064A |
|
463 |
428 |
$19K |
| 0012A |
|
485 |
462 |
$18K |
| H2015 |
Comprehensive community support services, per 15 minutes |
788 |
29 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
48,621 |
35,476 |
$7K |
| H2010 |
Comprehensive medication services, per 15 minutes |
223 |
14 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
2,289 |
1,985 |
$7K |
| 0134A |
|
162 |
157 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
22,686 |
18,149 |
$3K |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
223 |
149 |
$2K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
985 |
835 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,129 |
703 |
$1K |
| 0094A |
|
29 |
29 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
964 |
886 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
4,360 |
3,454 |
$990.68 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
2,025 |
1,872 |
$772.14 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,065 |
5,881 |
$515.25 |
| 90832 |
Psychotherapy, 30 minutes with patient |
7,030 |
3,620 |
$431.22 |
| 90834 |
Psychotherapy, 45 minutes with patient |
4,097 |
1,984 |
$381.56 |
| D0220 |
Intraoral - periapical first radiographic image |
2,116 |
1,868 |
$257.28 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
465 |
442 |
$256.95 |
| 96156 |
|
3,083 |
1,822 |
$224.84 |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,846 |
825 |
$177.14 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,413 |
3,059 |
$172.97 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
72 |
70 |
$141.32 |
| 96152 |
|
1,608 |
899 |
$117.28 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
353 |
152 |
$87.69 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
651 |
612 |
$39.24 |
| D0210 |
Intraoral - complete series of radiographic images |
603 |
556 |
$35.52 |
| D9995 |
|
76 |
58 |
$25.00 |
| 90686 |
|
416 |
409 |
$22.35 |
| 90656 |
|
292 |
291 |
$20.64 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,019 |
979 |
$10.05 |
| 86580 |
|
108 |
76 |
$4.00 |
| D1206 |
Topical application of fluoride varnish |
228 |
152 |
$0.00 |
| 3008F |
|
1,144 |
970 |
$0.00 |
| 99386 |
|
1,495 |
1,441 |
$0.00 |
| 1036F |
|
116 |
104 |
$0.00 |
| 3080F |
|
271 |
247 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
646 |
449 |
$0.00 |
| 3075F |
|
298 |
282 |
$0.00 |
| 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 |
351 |
255 |
$0.00 |
| 99385 |
|
1,162 |
1,125 |
$0.00 |
| 3074F |
|
1,048 |
936 |
$0.00 |
| 1034F |
|
89 |
82 |
$0.00 |
| 3079F |
|
393 |
369 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
53 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
28 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
313 |
$0.00 |
| 1126F |
|
81 |
66 |
$0.00 |
| 2000F |
|
221 |
189 |
$0.00 |
| 4010F |
|
29 |
26 |
$0.00 |
| D2331 |
|
17 |
13 |
$0.00 |
| D2330 |
|
16 |
12 |
$0.00 |
| 3078F |
|
1,189 |
1,040 |
$0.00 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
475 |
423 |
$0.00 |
| 3077F |
|
510 |
459 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
429 |
377 |
$0.00 |
| D4341 |
|
205 |
100 |
$0.00 |
| 1159F |
|
176 |
157 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
224 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
892 |
827 |
$0.00 |
| D4910 |
|
253 |
213 |
$0.00 |
| 82948 |
|
155 |
136 |
$0.00 |
| D1110 |
Prophylaxis - adult |
606 |
519 |
$0.00 |
| 1160F |
|
176 |
157 |
$0.00 |
| 81025 |
|
27 |
27 |
$0.00 |
| 80305 |
|
204 |
177 |
$0.00 |
| 4145F |
|
136 |
129 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
46 |
31 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
57 |
52 |
$0.00 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$0.00 |
| 90658 |
|
12 |
12 |
$0.00 |