| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
38,157 |
30,430 |
$6.05M |
| 99050 |
|
3,875 |
3,542 |
$189K |
| D9450 |
|
25,017 |
12,855 |
$176K |
| 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 |
4,825 |
3,726 |
$152K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,325 |
16,116 |
$145K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,839 |
3,976 |
$135K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,656 |
4,154 |
$118K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,544 |
2,520 |
$110K |
| D1110 |
Prophylaxis - adult |
6,432 |
4,495 |
$109K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
583 |
582 |
$99K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
573 |
573 |
$97K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
2,652 |
1,496 |
$94K |
| D9110 |
|
3,550 |
1,769 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,806 |
694 |
$76K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
427 |
402 |
$72K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,126 |
5,626 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,081 |
2,247 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
2,596 |
1,795 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
5,553 |
4,007 |
$53K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
282 |
282 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,418 |
1,782 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,082 |
1,387 |
$43K |
| D1120 |
Prophylaxis - child |
893 |
870 |
$43K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,785 |
3,730 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,392 |
1,782 |
$37K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
227 |
221 |
$36K |
| 92341 |
|
1,035 |
1,033 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,284 |
1,781 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,001 |
964 |
$28K |
| 99188 |
|
1,064 |
1,064 |
$27K |
| V2020 |
Frames, purchases |
275 |
272 |
$27K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,628 |
1,599 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
347 |
347 |
$23K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,788 |
3,157 |
$19K |
| 92015 |
Determination of refractive state |
1,585 |
1,578 |
$19K |
| D2331 |
|
760 |
491 |
$17K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,191 |
1,299 |
$14K |
| D2330 |
|
623 |
351 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
446 |
303 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,177 |
536 |
$9K |
| 90461 |
|
761 |
552 |
$9K |
| 11721 |
|
492 |
455 |
$7K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
226 |
213 |
$7K |
| 81025 |
|
888 |
853 |
$5K |
| D2140 |
|
184 |
145 |
$5K |
| 90682 |
|
201 |
184 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
385 |
368 |
$5K |
| 90688 |
|
1,159 |
1,153 |
$5K |
| 82947 |
|
1,691 |
1,528 |
$5K |
| 90746 |
|
66 |
66 |
$4K |
| 97802 |
|
72 |
58 |
$4K |
| D2332 |
|
117 |
73 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
82 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
85 |
$3K |
| 90715 |
|
181 |
180 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
854 |
804 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
41 |
$2K |
| H0001 |
Alcohol and/or drug assessment |
2,237 |
1,122 |
$2K |
| D0272 |
Bitewings - two radiographic images |
75 |
65 |
$2K |
| 90651 |
|
155 |
154 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
245 |
236 |
$2K |
| 97803 |
|
47 |
43 |
$2K |
| D2160 |
|
47 |
31 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
103 |
101 |
$1K |
| D2335 |
|
21 |
13 |
$1K |
| 81002 |
|
448 |
365 |
$1K |
| 90686 |
|
67 |
67 |
$957.11 |
| D4341 |
|
239 |
142 |
$925.00 |
| 90670 |
|
261 |
254 |
$858.48 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
66 |
66 |
$756.67 |
| 98928 |
|
12 |
12 |
$588.43 |
| 36415 |
Collection of venous blood by venipuncture |
650 |
602 |
$532.44 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
92 |
91 |
$507.10 |
| 99442 |
|
27 |
25 |
$484.38 |
| 90658 |
|
59 |
58 |
$452.19 |
| 99051 |
|
190 |
178 |
$436.92 |
| 90734 |
|
104 |
104 |
$416.64 |
| 81003 |
|
171 |
159 |
$363.79 |
| 92552 |
|
16 |
16 |
$332.96 |
| 99173 |
|
16 |
16 |
$320.00 |
| G0008 |
Administration of influenza virus vaccine |
59 |
50 |
$237.14 |
| 90473 |
|
17 |
16 |
$182.30 |
| 90716 |
|
44 |
43 |
$77.20 |
| 90647 |
|
251 |
246 |
$26.63 |
| A9150 |
Non-prescription drugs |
14 |
14 |
$25.05 |
| 90657 |
|
149 |
149 |
$11.36 |
| 94760 |
|
40 |
39 |
$4.78 |
| 90832 |
Psychotherapy, 30 minutes with patient |
159 |
130 |
$0.00 |
| 90681 |
|
18 |
17 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
42 |
41 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
17 |
12 |
$0.00 |
| 90633 |
|
293 |
292 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
16 |
16 |
$0.00 |
| 90707 |
|
26 |
26 |
$0.00 |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
28 |
27 |
$0.00 |
| 90710 |
|
33 |
33 |
$0.00 |
| 90680 |
|
127 |
125 |
$0.00 |
| 90696 |
|
33 |
33 |
$0.00 |
| 90723 |
|
159 |
156 |
$0.00 |
| 96151 |
|
143 |
81 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
12 |
12 |
$0.00 |