| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
58,117 |
30,055 |
$6.06M |
| D0999 |
Unspecified diagnostic procedure, by report |
28,579 |
23,867 |
$3.45M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
3,815 |
2,504 |
$292K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,109 |
954 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,401 |
12,296 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,905 |
6,581 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
11,470 |
6,134 |
$7K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
4,271 |
980 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,427 |
2,681 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,753 |
2,706 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,182 |
3,529 |
$2K |
| D1120 |
Prophylaxis - child |
5,805 |
5,734 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
6,621 |
6,541 |
$1K |
| D1110 |
Prophylaxis - adult |
1,560 |
1,531 |
$1K |
| D1206 |
Topical application of fluoride varnish |
5,794 |
5,709 |
$1K |
| 80305 |
|
6,668 |
4,250 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,650 |
2,134 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
705 |
506 |
$843.92 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
574 |
526 |
$841.75 |
| D0210 |
Intraoral - complete series of radiographic images |
1,713 |
1,703 |
$776.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,213 |
3,183 |
$761.18 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,099 |
1,696 |
$697.80 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
251 |
182 |
$485.84 |
| 96127 |
|
8,471 |
6,654 |
$481.80 |
| 90791 |
Psychiatric diagnostic evaluation |
1,160 |
1,047 |
$462.74 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,360 |
1,192 |
$344.55 |
| D0274 |
Bitewings - four radiographic images |
2,685 |
2,665 |
$308.38 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
249 |
218 |
$278.40 |
| D0140 |
Limited oral evaluation - problem focused |
1,981 |
1,938 |
$245.92 |
| D0330 |
Panoramic radiographic image |
2,351 |
2,341 |
$167.67 |
| D4341 |
|
18 |
13 |
$122.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
74 |
74 |
$108.99 |
| D0220 |
Intraoral - periapical first radiographic image |
2,299 |
2,279 |
$92.63 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
317 |
312 |
$81.59 |
| D2331 |
|
101 |
89 |
$51.90 |
| D2330 |
|
251 |
198 |
$34.60 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
76 |
73 |
$31.30 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
448 |
414 |
$29.43 |
| D0272 |
Bitewings - two radiographic images |
1,342 |
1,339 |
$22.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
464 |
461 |
$13.44 |
| 81025 |
|
81 |
43 |
$2.58 |
| 99173 |
|
112 |
111 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
63 |
57 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
2,224 |
1,814 |
$0.00 |
| 99408 |
|
1,850 |
959 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
74 |
73 |
$0.00 |
| D5110 |
|
27 |
27 |
$0.00 |
| 86703 |
|
46 |
46 |
$0.00 |
| 82075 |
|
194 |
120 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
13 |
13 |
$0.00 |
| 90838 |
|
493 |
163 |
$0.00 |
| D2332 |
|
97 |
83 |
$0.00 |
| D5899 |
|
1,496 |
1,206 |
$0.00 |
| D0603 |
|
1,325 |
1,303 |
$0.00 |
| D0601 |
|
3,991 |
3,937 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
4,685 |
3,933 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,121 |
512 |
$0.00 |
| D0602 |
|
3,034 |
3,003 |
$0.00 |
| 99383 |
|
49 |
49 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
560 |
439 |
$0.00 |
| H0049 |
Alcohol and/or drug screening |
753 |
591 |
$0.00 |
| D1330 |
|
232 |
155 |
$0.00 |
| G0477 |
Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
90 |
72 |
$0.00 |
| D4355 |
|
13 |
13 |
$0.00 |
| D9310 |
|
74 |
74 |
$0.00 |
| 99384 |
|
21 |
21 |
$0.00 |