| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,833 |
15,839 |
$2.38M |
| D0999 |
Unspecified diagnostic procedure, by report |
18,421 |
15,733 |
$2.01M |
| D9999 |
Unspecified adjunctive procedure, by report |
245 |
197 |
$37K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
27 |
18 |
$2K |
| 90670 |
|
964 |
695 |
$1K |
| 90651 |
|
56 |
50 |
$211.27 |
| 90710 |
|
370 |
269 |
$208.81 |
| 90633 |
|
473 |
359 |
$137.60 |
| 90734 |
|
118 |
88 |
$133.35 |
| 90686 |
|
766 |
596 |
$120.75 |
| 90715 |
|
52 |
52 |
$38.67 |
| 90685 |
|
115 |
64 |
$28.21 |
| D0120 |
Periodic oral evaluation - established patient |
6,806 |
6,442 |
$23.06 |
| D0220 |
Intraoral - periapical first radiographic image |
2,806 |
2,667 |
$5.60 |
| D1206 |
Topical application of fluoride varnish |
7,846 |
7,501 |
$0.12 |
| D1120 |
Prophylaxis - child |
7,504 |
7,235 |
$0.10 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,180 |
997 |
$0.00 |
| 90723 |
|
694 |
503 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
3,231 |
3,084 |
$0.00 |
| D0603 |
|
2,962 |
2,895 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
661 |
596 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,878 |
7,016 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
816 |
771 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
710 |
477 |
$0.00 |
| 90474 |
|
336 |
234 |
$0.00 |
| D1351 |
Sealant - per tooth |
708 |
285 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,082 |
2,002 |
$0.00 |
| 3075F |
|
195 |
142 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,082 |
2,990 |
$0.00 |
| D0602 |
|
550 |
547 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| D0601 |
|
1,027 |
1,008 |
$0.00 |
| 3079F |
|
657 |
430 |
$0.00 |
| 3074F |
|
773 |
538 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,280 |
1,043 |
$0.00 |
| 90647 |
|
656 |
506 |
$0.00 |
| 99441 |
|
186 |
119 |
$0.00 |
| 36416 |
|
1,211 |
864 |
$0.00 |
| D1330 |
|
210 |
192 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,482 |
1,171 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
665 |
276 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
819 |
567 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
278 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
40 |
39 |
$0.00 |
| 90688 |
|
92 |
62 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,061 |
2,352 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
237 |
168 |
$0.00 |
| 2010F |
|
209 |
197 |
$0.00 |
| D1310 |
|
27 |
27 |
$0.00 |
| 90680 |
|
266 |
181 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
63 |
$0.00 |
| 2000F |
|
175 |
166 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
158 |
122 |
$0.00 |
| 2001F |
|
16 |
13 |
$0.00 |
| 1034F |
|
23 |
20 |
$0.00 |
| 82043 |
|
87 |
56 |
$0.00 |
| 3008F |
|
206 |
194 |
$0.00 |
| 1036F |
|
121 |
117 |
$0.00 |
| 3351F |
|
63 |
62 |
$0.00 |
| 4037F |
|
18 |
18 |
$0.00 |
| 94760 |
|
15 |
14 |
$0.00 |
| 99381 |
|
12 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
2,424 |
2,309 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,582 |
1,317 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
995 |
727 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,239 |
945 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,913 |
1,460 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
558 |
442 |
$0.00 |
| 3078F |
|
677 |
458 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,629 |
1,457 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,681 |
1,595 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,228 |
917 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
359 |
346 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
71 |
56 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
22 |
13 |
$0.00 |
| 99442 |
|
108 |
73 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
908 |
606 |
$0.00 |
| 1160F |
|
177 |
169 |
$0.00 |
| 82570 |
|
84 |
55 |
$0.00 |
| D2940 |
|
225 |
165 |
$0.00 |
| 3077F |
|
450 |
263 |
$0.00 |
| 81003 |
|
356 |
173 |
$0.00 |
| 80061 |
Lipid panel |
340 |
258 |
$0.00 |
| 4274F |
|
66 |
63 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
34 |
32 |
$0.00 |
| 81025 |
|
105 |
67 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
34 |
26 |
$0.00 |
| 90756 |
|
68 |
50 |
$0.00 |
| 90681 |
|
12 |
12 |
$0.00 |
| 1159F |
|
177 |
169 |
$0.00 |
| 0502F |
|
81 |
26 |
$0.00 |
| 3045F |
|
55 |
26 |
$0.00 |
| D1354 |
|
20 |
15 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$0.00 |
| 4040F |
|
28 |
27 |
$0.00 |