| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,287 |
5,308 |
$572K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,961 |
3,279 |
$85K |
| D1120 |
Prophylaxis - child |
1,802 |
1,774 |
$58K |
| D0999 |
Unspecified diagnostic procedure, by report |
358 |
338 |
$46K |
| D1351 |
Sealant - per tooth |
586 |
584 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
350 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,244 |
1,237 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,769 |
1,743 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,185 |
1,184 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
705 |
685 |
$22K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
156 |
148 |
$18K |
| D0274 |
Bitewings - four radiographic images |
508 |
506 |
$15K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
661 |
648 |
$15K |
| D0330 |
Panoramic radiographic image |
102 |
98 |
$8K |
| 99429 |
|
792 |
424 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
66 |
64 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
784 |
760 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
380 |
374 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
38 |
38 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,164 |
1,084 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
40 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
33 |
33 |
$4K |
| D1110 |
Prophylaxis - adult |
93 |
92 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
315 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
69 |
64 |
$1K |
| 99460 |
|
22 |
12 |
$462.41 |
| 90686 |
|
152 |
133 |
$380.48 |
| 99173 |
|
400 |
383 |
$260.06 |
| 90670 |
|
103 |
99 |
$198.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30 |
29 |
$150.00 |
| 92552 |
|
27 |
26 |
$93.20 |
| 85018 |
|
724 |
692 |
$11.70 |
| 36416 |
|
167 |
157 |
$4.63 |
| 3074F |
|
740 |
594 |
$0.11 |
| 3079F |
|
250 |
191 |
$0.06 |
| 3078F |
|
397 |
307 |
$0.01 |
| 2001F |
|
781 |
695 |
$0.00 |
| 3008F |
|
830 |
650 |
$0.00 |
| 1220F |
|
19 |
19 |
$0.00 |
| 2010F |
|
775 |
688 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,296 |
792 |
$0.00 |
| 2000F |
|
284 |
264 |
$0.00 |
| 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 |
109 |
86 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
13 |
13 |
$0.00 |
| 1000F |
|
15 |
15 |
$0.00 |
| 90688 |
|
15 |
15 |
$0.00 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
15 |
14 |
$0.00 |
| 3028F |
|
668 |
598 |
$0.00 |
| 1100F |
|
120 |
105 |
$0.00 |
| 1160F |
|
186 |
165 |
$0.00 |
| 3077F |
|
14 |
12 |
$0.00 |
| 1159F |
|
52 |
52 |
$0.00 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
13 |
12 |
$0.00 |
| 81002 |
|
389 |
355 |
$0.00 |
| 3280F |
|
16 |
16 |
$0.00 |
| 81025 |
|
51 |
30 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
65 |
39 |
$0.00 |
| 90648 |
|
15 |
15 |
$0.00 |
| 1033F |
|
20 |
19 |
$0.00 |
| 90633 |
|
14 |
14 |
$0.00 |