| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,609 |
6,294 |
$1.49M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,443 |
21,885 |
$523K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
396 |
396 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
8,455 |
7,970 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
3,122 |
2,983 |
$106K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
6,501 |
6,074 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,418 |
6,045 |
$94K |
| D1110 |
Prophylaxis - adult |
4,057 |
3,914 |
$65K |
| D0330 |
Panoramic radiographic image |
5,658 |
5,233 |
$55K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,325 |
4,127 |
$45K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,685 |
2,620 |
$39K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,183 |
1,158 |
$38K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,085 |
1,024 |
$33K |
| D1120 |
Prophylaxis - child |
1,976 |
1,910 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
883 |
698 |
$28K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
874 |
866 |
$28K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
761 |
751 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
1,122 |
1,107 |
$26K |
| 59514 |
|
69 |
41 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
5,813 |
5,364 |
$18K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,806 |
1,758 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
383 |
$17K |
| D0274 |
Bitewings - four radiographic images |
2,344 |
2,151 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,174 |
1,161 |
$10K |
| D2330 |
|
235 |
182 |
$8K |
| 90686 |
|
1,360 |
1,295 |
$7K |
| 90697 |
|
78 |
74 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,760 |
2,318 |
$6K |
| 0012A |
|
183 |
182 |
$6K |
| 90651 |
|
137 |
126 |
$5K |
| 90670 |
|
388 |
366 |
$5K |
| 90677 |
|
59 |
57 |
$5K |
| 0011A |
|
168 |
168 |
$5K |
| 99221 |
|
189 |
187 |
$4K |
| 0124A |
|
116 |
114 |
$4K |
| 90619 |
|
36 |
36 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
72 |
$4K |
| 0134A |
|
96 |
95 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
655 |
632 |
$3K |
| D1206 |
Topical application of fluoride varnish |
273 |
260 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
30 |
$2K |
| D1351 |
Sealant - per tooth |
134 |
38 |
$1K |
| 90734 |
|
95 |
94 |
$1K |
| 90474 |
|
114 |
110 |
$1K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
387 |
379 |
$1K |
| 90633 |
|
318 |
307 |
$1K |
| 90680 |
|
116 |
110 |
$982.21 |
| 81000 |
|
920 |
670 |
$846.46 |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
279 |
196 |
$836.23 |
| D0272 |
Bitewings - two radiographic images |
174 |
167 |
$775.00 |
| 90710 |
|
73 |
72 |
$770.19 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
196 |
195 |
$685.88 |
| D2331 |
|
16 |
15 |
$680.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
27 |
$675.01 |
| 90716 |
|
28 |
27 |
$636.99 |
| 0064A |
|
14 |
14 |
$560.00 |
| 0051A |
|
15 |
14 |
$474.00 |
| D0171 |
|
28 |
27 |
$420.00 |
| 90715 |
|
97 |
95 |
$403.04 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$391.62 |
| 90656 |
|
99 |
99 |
$317.01 |
| 90461 |
|
39 |
38 |
$279.40 |
| 90698 |
|
128 |
122 |
$264.20 |
| 90723 |
|
16 |
13 |
$260.49 |
| D4355 |
|
24 |
13 |
$231.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
12 |
12 |
$202.51 |
| D2940 |
|
17 |
17 |
$170.00 |
| D9110 |
|
13 |
13 |
$126.00 |
| 3074F |
|
12,780 |
11,421 |
$70.00 |
| 91301 |
|
349 |
348 |
$66.00 |
| 99217 |
|
28 |
24 |
$65.68 |
| 3078F |
|
12,510 |
11,226 |
$63.00 |
| 59025 |
Fetal non-stress test |
28 |
24 |
$32.00 |
| 90648 |
|
18 |
17 |
$18.24 |
| 90744 |
|
47 |
46 |
$18.00 |
| 3079F |
|
1,078 |
1,029 |
$9.00 |
| 82947 |
|
12 |
12 |
$6.00 |
| 3077F |
|
591 |
561 |
$5.00 |
| 91307 |
|
44 |
42 |
$4.00 |
| 91300 |
|
13 |
13 |
$3.00 |
| 3075F |
|
465 |
444 |
$1.00 |
| 3080F |
|
84 |
83 |
$1.00 |
| 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 |
129 |
120 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
167 |
93 |
$0.00 |
| 91305 |
|
32 |
28 |
$0.00 |
| 00000 |
|
12 |
12 |
$0.00 |
| 90696 |
|
16 |
16 |
$0.00 |
| 99383 |
|
51 |
51 |
$0.00 |
| 1127F |
|
15 |
15 |
$0.00 |
| 99381 |
|
59 |
59 |
$0.00 |
| 0502F |
|
473 |
329 |
$0.00 |
| 99201 |
|
102 |
102 |
$0.00 |
| D1999 |
|
1,473 |
1,129 |
$0.00 |
| 91313 |
|
93 |
89 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
15 |
15 |
$0.00 |
| 87806 |
|
46 |
46 |
$0.00 |
| 91312 |
|
126 |
125 |
$0.00 |
| 99173 |
|
51 |
51 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
44 |
41 |
$0.00 |
| D5986 |
|
26 |
21 |
$0.00 |