| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,080 |
7,282 |
$1.31M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,367 |
1,081 |
$161K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
391 |
292 |
$27K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,787 |
3,250 |
$5.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
217 |
190 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
197 |
123 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
318 |
238 |
$0.00 |
| 81000 |
|
203 |
192 |
$0.00 |
| 99385 |
|
62 |
55 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
93 |
92 |
$0.00 |
| 99386 |
|
43 |
41 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
41 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
27 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
143 |
107 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| 90686 |
|
14 |
14 |
$0.00 |
| 99383 |
|
27 |
22 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,001 |
912 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
275 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
204 |
198 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
153 |
147 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
51 |
34 |
$0.00 |
| 81025 |
|
399 |
373 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
33 |
29 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
39 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
29 |
28 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
14 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
20 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
25 |
24 |
$0.00 |
| 90461 |
|
33 |
16 |
$0.00 |