| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
25,430 |
21,280 |
$5.00M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,035 |
10,700 |
$242K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,671 |
1,580 |
$88K |
| D0999 |
Unspecified diagnostic procedure, by report |
895 |
846 |
$71K |
| 99381 |
|
175 |
174 |
$24K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
956 |
947 |
$20K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
130 |
128 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
346 |
328 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
742 |
698 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
276 |
273 |
$14K |
| 90834 |
Psychotherapy, 45 minutes with patient |
373 |
277 |
$13K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
591 |
583 |
$13K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
509 |
506 |
$12K |
| 99385 |
|
39 |
39 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
151 |
149 |
$8K |
| 99383 |
|
55 |
55 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| 0072A |
|
41 |
41 |
$1K |
| D1206 |
Topical application of fluoride varnish |
209 |
208 |
$1K |
| D1120 |
Prophylaxis - child |
68 |
68 |
$992.25 |
| 90791 |
Psychiatric diagnostic evaluation |
25 |
25 |
$914.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
533 |
182 |
$748.15 |
| 0071A |
|
22 |
22 |
$720.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
15 |
$657.51 |
| D0120 |
Periodic oral evaluation - established patient |
43 |
42 |
$577.00 |
| D0220 |
Intraoral - periapical first radiographic image |
186 |
185 |
$391.80 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$384.16 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$247.24 |
| 0001A |
|
24 |
24 |
$240.00 |
| 0002A |
|
12 |
12 |
$160.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,123 |
3,049 |
$153.06 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$140.90 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,610 |
1,594 |
$118.16 |
| 59430 |
|
15 |
15 |
$102.92 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,124 |
1,097 |
$96.25 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
644 |
629 |
$55.60 |
| 87430 |
|
521 |
503 |
$28.24 |
| 90461 |
|
1,278 |
1,230 |
$18.47 |
| D0603 |
|
576 |
572 |
$18.02 |
| 90686 |
|
1,141 |
1,122 |
$17.52 |
| 81025 |
|
239 |
233 |
$7.23 |
| 82948 |
|
98 |
77 |
$4.23 |
| 81005 |
|
598 |
569 |
$3.64 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,033 |
1,030 |
$0.00 |
| 90697 |
|
239 |
229 |
$0.00 |
| 96161 |
|
802 |
701 |
$0.00 |
| 90680 |
|
645 |
634 |
$0.00 |
| 90723 |
|
77 |
74 |
$0.00 |
| 90698 |
|
25 |
25 |
$0.00 |
| 90656 |
|
161 |
160 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 96127 |
|
26 |
25 |
$0.00 |
| 92551 |
|
14 |
13 |
$0.00 |
| 90651 |
|
76 |
76 |
$0.00 |
| 90670 |
|
677 |
673 |
$0.00 |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
209 |
204 |
$0.00 |
| 86328 |
|
349 |
341 |
$0.00 |
| 90671 |
|
373 |
360 |
$0.00 |
| 90715 |
|
243 |
242 |
$0.00 |
| 90710 |
|
142 |
136 |
$0.00 |
| 90648 |
|
159 |
158 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
124 |
121 |
$0.00 |
| 90633 |
|
169 |
168 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| 90734 |
|
52 |
51 |
$0.00 |