| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,537 |
22,667 |
$4.47M |
| D0999 |
Unspecified diagnostic procedure, by report |
7,203 |
6,200 |
$815K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
509 |
349 |
$33K |
| 99000 |
|
678 |
572 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,595 |
15,778 |
$706.98 |
| 90686 |
|
1,118 |
1,095 |
$482.73 |
| 90688 |
|
99 |
88 |
$138.68 |
| D1120 |
Prophylaxis - child |
1,754 |
1,694 |
$82.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,452 |
2,351 |
$56.00 |
| D1206 |
Topical application of fluoride varnish |
2,731 |
2,584 |
$52.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
333 |
284 |
$48.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,992 |
1,832 |
$45.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
538 |
$21.05 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
846 |
767 |
$17.05 |
| D0220 |
Intraoral - periapical first radiographic image |
2,624 |
2,414 |
$16.80 |
| D0140 |
Limited oral evaluation - problem focused |
178 |
152 |
$16.20 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
533 |
458 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
325 |
320 |
$0.00 |
| D0603 |
|
268 |
236 |
$0.00 |
| 1036F |
|
7,185 |
6,028 |
$0.00 |
| 90677 |
|
60 |
60 |
$0.00 |
| D1351 |
Sealant - per tooth |
409 |
206 |
$0.00 |
| 96127 |
|
2,244 |
2,034 |
$0.00 |
| 3008F |
|
8,203 |
7,046 |
$0.00 |
| 90656 |
|
169 |
157 |
$0.00 |
| 3074F |
|
5,754 |
5,051 |
$0.00 |
| 3079F |
|
1,699 |
1,570 |
$0.00 |
| 3075F |
|
1,024 |
952 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
83 |
83 |
$0.00 |
| 1126F |
|
67 |
56 |
$0.00 |
| 90698 |
|
17 |
16 |
$0.00 |
| 90651 |
|
112 |
112 |
$0.00 |
| 3080F |
|
263 |
242 |
$0.00 |
| 90619 |
|
67 |
66 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
82 |
$0.00 |
| 90680 |
|
28 |
27 |
$0.00 |
| D9995 |
|
16 |
14 |
$0.00 |
| 90696 |
|
16 |
16 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
529 |
482 |
$0.00 |
| 3077F |
|
862 |
774 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
294 |
278 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,121 |
1,082 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,559 |
1,486 |
$0.00 |
| 90633 |
|
51 |
51 |
$0.00 |
| 1160F |
|
7,228 |
6,053 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
669 |
544 |
$0.00 |
| 0502F |
|
858 |
614 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
490 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
329 |
304 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
521 |
356 |
$0.00 |
| 3725F |
|
6,397 |
5,525 |
$0.00 |
| 3078F |
|
5,533 |
4,872 |
$0.00 |
| 90670 |
|
37 |
37 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
344 |
336 |
$0.00 |
| 90715 |
|
95 |
94 |
$0.00 |
| 90461 |
|
436 |
403 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
360 |
354 |
$0.00 |
| 90714 |
|
14 |
14 |
$0.00 |
| 90710 |
|
46 |
45 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
234 |
227 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
20 |
20 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
102 |
99 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
61 |
53 |
$0.00 |
| D0270 |
|
25 |
24 |
$0.00 |