| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
32,096 |
27,203 |
$4.68M |
| D9450 |
|
31,572 |
17,276 |
$955K |
| 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 |
988 |
941 |
$216K |
| D1110 |
Prophylaxis - adult |
6,385 |
4,740 |
$171K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,059 |
665 |
$148K |
| 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 |
3,975 |
3,322 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,262 |
1,032 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,940 |
2,267 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,908 |
2,101 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
5,484 |
3,203 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
3,459 |
2,384 |
$115K |
| D0330 |
Panoramic radiographic image |
2,106 |
1,326 |
$85K |
| 99050 |
|
1,544 |
1,456 |
$71K |
| D0274 |
Bitewings - four radiographic images |
4,005 |
2,958 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
5,881 |
4,297 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,414 |
2,332 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,755 |
3,273 |
$48K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,031 |
11,073 |
$37K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,960 |
1,616 |
$36K |
| D2331 |
|
927 |
378 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
796 |
449 |
$29K |
| 80305 |
|
3,097 |
2,504 |
$26K |
| D2330 |
|
907 |
313 |
$26K |
| 90746 |
|
273 |
273 |
$18K |
| D9110 |
|
656 |
355 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
136 |
58 |
$14K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,364 |
4,008 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,272 |
2,221 |
$12K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
69 |
67 |
$11K |
| 90674 |
|
652 |
645 |
$9K |
| 90715 |
|
328 |
327 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,641 |
2,421 |
$7K |
| D1206 |
Topical application of fluoride varnish |
162 |
150 |
$4K |
| D2332 |
|
69 |
28 |
$3K |
| 90686 |
|
210 |
210 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,514 |
1,279 |
$3K |
| D0180 |
|
175 |
94 |
$3K |
| 91322 |
|
55 |
55 |
$2K |
| 90661 |
|
104 |
104 |
$2K |
| D2335 |
|
16 |
13 |
$2K |
| 90480 |
|
52 |
51 |
$2K |
| 99051 |
|
87 |
80 |
$1K |
| 0134A |
|
33 |
31 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
38 |
$694.00 |
| 90653 |
|
31 |
31 |
$546.84 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
370 |
321 |
$502.75 |
| 99173 |
|
13 |
13 |
$270.12 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
51 |
51 |
$267.95 |
| D0272 |
Bitewings - two radiographic images |
19 |
12 |
$266.00 |
| 93000 |
|
13 |
13 |
$199.55 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
26 |
26 |
$177.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$116.76 |
| 81002 |
|
39 |
37 |
$95.86 |
| 81025 |
|
12 |
12 |
$69.96 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
54 |
53 |
$11.25 |
| D9995 |
|
528 |
264 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 91306 |
|
22 |
12 |
$0.00 |
| 91301 |
|
96 |
96 |
$0.00 |
| 90656 |
|
17 |
16 |
$0.00 |
| 91300 |
|
17 |
15 |
$0.00 |
| 91313 |
|
56 |
53 |
$0.00 |
| D0350 |
|
26 |
12 |
$0.00 |