| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,922 |
10,883 |
$1.61M |
| D0999 |
Unspecified diagnostic procedure, by report |
14,299 |
11,644 |
$1.40M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,662 |
872 |
$119K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,053 |
864 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,665 |
3,560 |
$14K |
| D1120 |
Prophylaxis - child |
3,786 |
3,686 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
1,246 |
1,178 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,129 |
1,114 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,037 |
840 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
982 |
802 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,044 |
661 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,302 |
6,506 |
$1K |
| D1110 |
Prophylaxis - adult |
183 |
182 |
$1K |
| D1206 |
Topical application of fluoride varnish |
3,855 |
3,751 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,249 |
1,198 |
$868.56 |
| D2940 |
|
144 |
128 |
$698.50 |
| D0330 |
Panoramic radiographic image |
849 |
842 |
$374.84 |
| 90837 |
Psychotherapy, 53 minutes with patient |
658 |
315 |
$298.25 |
| D2330 |
|
27 |
24 |
$216.16 |
| D0274 |
Bitewings - four radiographic images |
1,446 |
1,414 |
$194.34 |
| D0210 |
Intraoral - complete series of radiographic images |
211 |
207 |
$173.70 |
| D0272 |
Bitewings - two radiographic images |
662 |
642 |
$165.40 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
343 |
278 |
$139.97 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,088 |
1,652 |
$125.71 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$108.08 |
| 90791 |
Psychiatric diagnostic evaluation |
52 |
42 |
$102.64 |
| D9110 |
|
32 |
27 |
$55.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
361 |
265 |
$51.30 |
| 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 |
13 |
12 |
$39.57 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
596 |
568 |
$31.40 |
| 3077F |
|
114 |
106 |
$0.00 |
| 1160F |
|
1,668 |
1,458 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
270 |
236 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
60 |
59 |
$0.00 |
| 3078F |
|
1,239 |
1,120 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
276 |
159 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
430 |
408 |
$0.00 |
| 4004F |
|
66 |
64 |
$0.00 |
| 1159F |
|
1,672 |
1,459 |
$0.00 |
| 4274F |
|
151 |
136 |
$0.00 |
| 81003 |
|
78 |
75 |
$0.00 |
| 4040F |
|
62 |
52 |
$0.00 |
| D0270 |
|
29 |
29 |
$0.00 |
| D4910 |
|
12 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
25 |
25 |
$0.00 |
| 90734 |
|
14 |
13 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
15 |
$0.00 |
| D2332 |
|
16 |
13 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
495 |
371 |
$0.00 |
| 2010F |
|
2,067 |
1,795 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
159 |
158 |
$0.00 |
| 1036F |
|
1,212 |
1,057 |
$0.00 |
| 3079F |
|
531 |
493 |
$0.00 |
| 2000F |
|
1,935 |
1,690 |
$0.00 |
| 3008F |
|
1,947 |
1,714 |
$0.00 |
| 4037F |
|
14 |
14 |
$0.00 |
| 3075F |
|
229 |
218 |
$0.00 |
| 3074F |
|
1,508 |
1,353 |
$0.00 |
| 1034F |
|
544 |
466 |
$0.00 |
| D1351 |
Sealant - per tooth |
60 |
34 |
$0.00 |
| 1126F |
|
217 |
207 |
$0.00 |
| 4010F |
|
68 |
59 |
$0.00 |
| 3080F |
|
66 |
63 |
$0.00 |
| 1125F |
|
108 |
98 |
$0.00 |
| 2001F |
|
112 |
100 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
12 |
12 |
$0.00 |
| 87807 |
|
16 |
16 |
$0.00 |
| D9995 |
|
47 |
30 |
$0.00 |
| 1170F |
|
23 |
23 |
$0.00 |
| 90686 |
|
13 |
12 |
$0.00 |
| D5899 |
|
22 |
14 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$0.00 |
| D2335 |
|
12 |
12 |
$0.00 |