| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
100,375 |
76,630 |
$14.88M |
| H0011 |
Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) |
2,311 |
2,274 |
$4.09M |
| D9450 |
|
57,354 |
35,756 |
$1.57M |
| H0010 |
Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) |
128 |
127 |
$786K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,918 |
3,908 |
$564K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,869 |
3,854 |
$539K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,401 |
3,153 |
$519K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17,473 |
14,470 |
$493K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,099 |
3,089 |
$438K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
10,153 |
10,082 |
$428K |
| 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 |
11,989 |
9,442 |
$413K |
| D0140 |
Limited oral evaluation - problem focused |
11,392 |
6,334 |
$229K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,581 |
877 |
$221K |
| D0210 |
Intraoral - complete series of radiographic images |
6,459 |
4,739 |
$209K |
| D1110 |
Prophylaxis - adult |
7,828 |
5,819 |
$200K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
8,793 |
8,045 |
$197K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
854 |
563 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
11,220 |
8,422 |
$145K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14,947 |
14,855 |
$143K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,000 |
9,336 |
$140K |
| 99188 |
|
5,298 |
5,278 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,435 |
2,727 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,274 |
2,230 |
$127K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,488 |
1,991 |
$127K |
| D1120 |
Prophylaxis - child |
2,653 |
2,381 |
$120K |
| 92015 |
Determination of refractive state |
9,971 |
9,948 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,483 |
1,049 |
$119K |
| 92341 |
|
2,836 |
2,818 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,405 |
3,366 |
$96K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,425 |
1,424 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,857 |
3,690 |
$95K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,822 |
1,765 |
$93K |
| D4341 |
|
2,803 |
1,123 |
$83K |
| 80305 |
|
9,302 |
6,876 |
$80K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
518 |
518 |
$77K |
| D1206 |
Topical application of fluoride varnish |
3,077 |
2,739 |
$72K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
4,280 |
2,466 |
$71K |
| 90739 |
|
556 |
550 |
$70K |
| 87808 |
|
5,810 |
5,690 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
7,554 |
3,999 |
$62K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,016 |
1,991 |
$58K |
| 81025 |
|
8,685 |
8,206 |
$58K |
| 90750 |
|
371 |
366 |
$55K |
| 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 |
2,934 |
1,707 |
$54K |
| 0012A |
|
990 |
990 |
$46K |
| 0011A |
|
973 |
973 |
$41K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12,179 |
12,058 |
$41K |
| D0330 |
Panoramic radiographic image |
888 |
734 |
$39K |
| 92133 |
|
2,569 |
1,437 |
$37K |
| D4342 |
|
1,296 |
569 |
$36K |
| D1351 |
Sealant - per tooth |
1,090 |
278 |
$36K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
108 |
72 |
$27K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,108 |
1,025 |
$25K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,995 |
6,814 |
$24K |
| D2950 |
|
342 |
259 |
$23K |
| 0064A |
|
512 |
511 |
$23K |
| 97803 |
|
472 |
462 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,368 |
2,106 |
$21K |
| 0001A |
|
482 |
481 |
$21K |
| 0002A |
|
456 |
453 |
$21K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,556 |
1,534 |
$20K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,029 |
2,015 |
$18K |
| D0272 |
Bitewings - two radiographic images |
662 |
590 |
$17K |
| 0004A |
|
379 |
379 |
$17K |
| D9110 |
|
1,054 |
527 |
$17K |
| 90686 |
|
7,456 |
7,425 |
$17K |
| 90677 |
|
380 |
379 |
$14K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
2,029 |
1,974 |
$14K |
| 81002 |
|
5,235 |
4,725 |
$14K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,202 |
1,159 |
$13K |
| 97802 |
|
141 |
141 |
$13K |
| 0071A |
|
242 |
242 |
$11K |
| 0124A |
|
257 |
256 |
$11K |
| 90480 |
|
206 |
205 |
$9K |
| 90832 |
Psychotherapy, 30 minutes with patient |
356 |
244 |
$9K |
| 0072A |
|
184 |
184 |
$8K |
| 92134 |
|
661 |
358 |
$8K |
| 90716 |
|
1,016 |
1,008 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
125 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
944 |
375 |
$7K |
| D2331 |
|
182 |
116 |
$6K |
| 90670 |
|
2,030 |
2,024 |
$6K |
| 90734 |
|
1,076 |
1,069 |
$6K |
| 90746 |
|
277 |
276 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
101 |
92 |
$4K |
| 90461 |
|
4,823 |
4,752 |
$4K |
| D3320 |
|
14 |
13 |
$4K |
| D2330 |
|
99 |
69 |
$4K |
| 0013A |
|
72 |
72 |
$3K |
| 92083 |
|
426 |
219 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
167 |
148 |
$3K |
| D3310 |
|
19 |
13 |
$3K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
103 |
49 |
$3K |
| 99383 |
|
15 |
15 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
177 |
173 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
21 |
21 |
$2K |
| D0270 |
|
363 |
239 |
$2K |
| 99381 |
|
12 |
12 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
816 |
793 |
$2K |
| 90674 |
|
2,059 |
2,043 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$904.00 |
| D2140 |
|
14 |
12 |
$732.00 |
| V2020 |
Frames, purchases |
12 |
12 |
$730.00 |
| 90887 |
|
16 |
15 |
$721.92 |
| 0134A |
|
15 |
15 |
$642.18 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
698 |
682 |
$435.10 |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
13 |
13 |
$393.76 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$378.00 |
| 99441 |
|
30 |
30 |
$301.56 |
| 90715 |
|
1,941 |
1,931 |
$223.97 |
| 90655 |
|
331 |
331 |
$15.45 |
| 91320 |
|
124 |
124 |
$0.07 |
| 91306 |
|
492 |
492 |
$0.02 |
| 91300 |
|
1,372 |
1,278 |
$0.00 |
| 90633 |
|
2,071 |
2,065 |
$0.00 |
| 90714 |
|
127 |
126 |
$0.00 |
| 90707 |
|
966 |
962 |
$0.00 |
| 91308 |
|
29 |
27 |
$0.00 |
| 90681 |
|
287 |
287 |
$0.00 |
| 90710 |
|
247 |
247 |
$0.00 |
| 91312 |
|
270 |
268 |
$0.00 |
| 90700 |
|
313 |
313 |
$0.00 |
| 90661 |
|
149 |
149 |
$0.00 |
| 90671 |
|
176 |
176 |
$0.00 |
| 99051 |
|
15 |
15 |
$0.00 |
| 90649 |
|
12 |
12 |
$0.00 |
| 90672 |
|
17 |
17 |
$0.00 |
| 91313 |
|
15 |
15 |
$0.00 |
| 91307 |
|
584 |
534 |
$0.00 |
| 90680 |
|
899 |
894 |
$0.00 |
| 91301 |
|
1,975 |
1,932 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
608 |
594 |
$0.00 |
| 90723 |
|
1,110 |
1,106 |
$0.00 |
| 90697 |
|
527 |
527 |
$0.00 |
| 90651 |
|
2,099 |
2,091 |
$0.00 |
| 90698 |
|
1,667 |
1,662 |
$0.00 |
| 90696 |
|
253 |
253 |
$0.00 |
| D9995 |
|
6,343 |
3,607 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
335 |
325 |
$0.00 |
| 90619 |
|
450 |
449 |
$0.00 |
| 92250 |
|
74 |
37 |
$0.00 |
| D1330 |
|
5,638 |
3,182 |
$0.00 |
| 90381 |
|
13 |
13 |
$0.00 |
| 91319 |
|
32 |
32 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
12 |
12 |
$0.00 |
| D0603 |
|
21 |
20 |
$0.00 |
| 91318 |
|
12 |
12 |
$0.00 |