| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
11,257 |
5,472 |
$559K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,576 |
5,263 |
$554K |
| H0038 |
Self-help/peer services, per 15 minutes |
2,801 |
813 |
$173K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
2,151 |
992 |
$158K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,075 |
469 |
$139K |
| D1110 |
Prophylaxis - adult |
2,720 |
2,659 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,313 |
2,234 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
923 |
670 |
$69K |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
3,870 |
1,645 |
$51K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
714 |
572 |
$45K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,068 |
738 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
696 |
$30K |
| D4910 |
|
731 |
700 |
$30K |
| D1351 |
Sealant - per tooth |
1,622 |
605 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
281 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
535 |
520 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,170 |
2,097 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
567 |
560 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,686 |
1,551 |
$16K |
| D0191 |
|
2,014 |
1,906 |
$15K |
| D0274 |
Bitewings - four radiographic images |
475 |
470 |
$10K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
54 |
49 |
$9K |
| 90834 |
Psychotherapy, 45 minutes with patient |
90 |
48 |
$9K |
| D0603 |
|
2,120 |
2,047 |
$8K |
| D4341 |
|
187 |
95 |
$8K |
| H0006 |
Alcohol and/or drug services; case management |
404 |
319 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
84 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
29 |
25 |
$4K |
| 99215 |
Prolong outpt/office vis |
34 |
29 |
$3K |
| 90632 |
|
12 |
12 |
$715.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
48 |
44 |
$579.88 |
| D0270 |
|
69 |
67 |
$500.40 |
| D1353 |
|
70 |
36 |
$466.04 |
| D1999 |
|
41 |
36 |
$231.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
108 |
36 |
$101.23 |
| D9995 |
|
112 |
109 |
$42.00 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
12 |
$30.00 |
| 91313 |
|
12 |
12 |
$0.01 |
| D0999 |
Unspecified diagnostic procedure, by report |
214 |
212 |
$0.00 |
| D1330 |
|
2,817 |
2,621 |
$0.00 |
| D9910 |
|
1,177 |
1,147 |
$0.00 |
| D4921 |
|
114 |
84 |
$0.00 |