| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
200,954 |
164,429 |
$30.93M |
| D9450 |
|
136,499 |
79,267 |
$3.18M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
15,202 |
10,163 |
$2.13M |
| 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 |
10,455 |
8,938 |
$1.73M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
10,405 |
9,740 |
$1.54M |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,260 |
8,252 |
$1.23M |
| 90834 |
Psychotherapy, 45 minutes with patient |
15,324 |
10,015 |
$1.15M |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
7,496 |
7,494 |
$1.12M |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
6,642 |
6,640 |
$1.00M |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
5,213 |
5,209 |
$794K |
| D0140 |
Limited oral evaluation - problem focused |
31,201 |
16,673 |
$655K |
| D1110 |
Prophylaxis - adult |
28,215 |
21,881 |
$594K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,726 |
4,420 |
$498K |
| 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 |
11,799 |
9,698 |
$375K |
| D0120 |
Periodic oral evaluation - established patient |
27,353 |
22,129 |
$337K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,043 |
8,919 |
$333K |
| 99381 |
|
1,645 |
1,633 |
$309K |
| D1120 |
Prophylaxis - child |
5,935 |
5,884 |
$305K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,848 |
8,323 |
$285K |
| D0210 |
Intraoral - complete series of radiographic images |
11,560 |
8,933 |
$252K |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,444 |
5,611 |
$251K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,591 |
3,589 |
$244K |
| D0220 |
Intraoral - periapical first radiographic image |
26,024 |
14,287 |
$222K |
| D2740 |
Crown - porcelain/ceramic |
1,158 |
926 |
$218K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,840 |
8,580 |
$208K |
| 99050 |
|
4,600 |
4,518 |
$207K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,918 |
3,915 |
$196K |
| D0274 |
Bitewings - four radiographic images |
12,108 |
9,576 |
$188K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
45,934 |
45,414 |
$186K |
| 97802 |
|
3,206 |
3,201 |
$168K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
16,158 |
15,976 |
$156K |
| 97803 |
|
4,330 |
4,183 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,290 |
5,234 |
$153K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,558 |
5,095 |
$151K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
4,684 |
4,612 |
$150K |
| D1351 |
Sealant - per tooth |
3,382 |
908 |
$137K |
| D0180 |
|
9,848 |
7,419 |
$130K |
| 90746 |
|
1,811 |
1,805 |
$118K |
| 90686 |
|
18,650 |
18,637 |
$115K |
| D2331 |
|
3,448 |
2,290 |
$103K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
407 |
364 |
$101K |
| D2335 |
|
1,922 |
1,259 |
$92K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
3,838 |
3,726 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,070 |
2,302 |
$89K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
575 |
389 |
$88K |
| 92015 |
Determination of refractive state |
7,796 |
7,779 |
$87K |
| 90715 |
|
4,709 |
4,704 |
$84K |
| D5212 |
|
535 |
409 |
$83K |
| D9110 |
|
3,598 |
1,952 |
$81K |
| D2330 |
|
2,983 |
1,678 |
$79K |
| 99173 |
|
3,831 |
3,829 |
$78K |
| D3320 |
|
503 |
427 |
$78K |
| D1206 |
Topical application of fluoride varnish |
2,872 |
2,854 |
$76K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,396 |
6,520 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,552 |
2,420 |
$69K |
| 99188 |
|
2,621 |
2,619 |
$68K |
| 0064A |
|
1,466 |
1,466 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,796 |
1,293 |
$66K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,311 |
2,299 |
$62K |
| D2332 |
|
1,527 |
981 |
$61K |
| 90632 |
|
1,216 |
1,213 |
$60K |
| D4341 |
|
2,535 |
1,012 |
$59K |
| 90688 |
|
3,800 |
3,797 |
$58K |
| 99384 |
|
327 |
327 |
$57K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
21,481 |
21,284 |
$55K |
| 92341 |
|
1,513 |
1,503 |
$52K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,744 |
2,726 |
$50K |
| D5211 |
|
286 |
214 |
$46K |
| 91322 |
|
373 |
372 |
$43K |
| 90791 |
Psychiatric diagnostic evaluation |
353 |
349 |
$42K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
3,118 |
3,052 |
$40K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
2,472 |
1,682 |
$36K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
111 |
110 |
$35K |
| D4342 |
|
1,775 |
708 |
$35K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,417 |
2,376 |
$33K |
| 0134A |
|
711 |
711 |
$32K |
| D0330 |
Panoramic radiographic image |
867 |
486 |
$32K |
| 81025 |
|
4,674 |
4,581 |
$32K |
| D2954 |
|
546 |
468 |
$31K |
| D2140 |
|
1,151 |
751 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
194 |
$31K |
| 0012A |
|
664 |
638 |
$30K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,593 |
3,584 |
$30K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
532 |
531 |
$27K |
| D3310 |
|
264 |
222 |
$27K |
| 90670 |
|
6,573 |
6,569 |
$27K |
| 93000 |
|
1,677 |
1,667 |
$26K |
| 99383 |
|
141 |
141 |
$25K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,079 |
2,834 |
$23K |
| 90651 |
|
4,832 |
4,829 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,376 |
1,276 |
$22K |
| 0011A |
|
530 |
530 |
$21K |
| 99385 |
|
140 |
140 |
$20K |
| 96127 |
|
2,104 |
2,087 |
$19K |
| 92551 |
|
1,942 |
1,939 |
$18K |
| 90707 |
|
2,494 |
2,492 |
$17K |
| 0072A |
|
329 |
328 |
$15K |
| 0071A |
|
316 |
315 |
$14K |
| 90716 |
|
2,629 |
2,626 |
$12K |
| 90480 |
|
280 |
279 |
$12K |
| 0054A |
|
257 |
257 |
$12K |
| 90620 |
|
2,017 |
2,016 |
$11K |
| 0002A |
|
242 |
242 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
661 |
629 |
$10K |
| 0001A |
|
220 |
219 |
$10K |
| D0270 |
|
2,270 |
1,912 |
$10K |
| D2160 |
|
276 |
179 |
$9K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
169 |
167 |
$8K |
| 81003 |
|
3,581 |
3,504 |
$7K |
| 11981 |
|
63 |
62 |
$7K |
| 0004A |
|
136 |
136 |
$6K |
| 90734 |
|
2,734 |
2,733 |
$6K |
| D2394 |
|
152 |
110 |
$5K |
| 0052A |
|
105 |
105 |
$5K |
| 90887 |
|
79 |
69 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,648 |
4,256 |
$5K |
| 90750 |
|
37 |
37 |
$3K |
| 90677 |
|
862 |
862 |
$3K |
| 86580 |
|
562 |
532 |
$3K |
| 0124A |
|
63 |
63 |
$3K |
| 90732 |
|
32 |
32 |
$3K |
| 0051A |
|
49 |
49 |
$2K |
| 90682 |
|
35 |
35 |
$2K |
| 0111A |
|
40 |
40 |
$2K |
| 90474 |
|
4,368 |
4,366 |
$2K |
| 11982 |
|
14 |
14 |
$2K |
| 90714 |
|
772 |
771 |
$2K |
| 90713 |
|
703 |
703 |
$2K |
| 0013A |
|
33 |
33 |
$2K |
| 90473 |
|
119 |
119 |
$1K |
| 92370 |
|
84 |
83 |
$939.96 |
| 87210 |
|
168 |
168 |
$859.42 |
| 97804 |
|
20 |
20 |
$702.24 |
| 0112A |
|
12 |
12 |
$550.44 |
| 0003A |
|
12 |
12 |
$550.44 |
| 99462 |
|
12 |
12 |
$402.60 |
| 59025 |
Fetal non-stress test |
47 |
28 |
$379.60 |
| 91301 |
|
6,676 |
6,518 |
$318.58 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
54 |
30 |
$20.00 |
| 94760 |
|
3,215 |
3,123 |
$14.18 |
| 82962 |
|
1,947 |
1,842 |
$6.50 |
| 90744 |
|
2,150 |
2,149 |
$0.00 |
| 90619 |
|
1,177 |
1,177 |
$0.00 |
| 90697 |
|
2,121 |
2,120 |
$0.00 |
| 90696 |
|
1,320 |
1,320 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
317 |
306 |
$0.00 |
| 90680 |
|
5,060 |
5,057 |
$0.00 |
| 91306 |
|
1,513 |
1,513 |
$0.00 |
| 90698 |
|
2,794 |
2,790 |
$0.00 |
| 90723 |
|
793 |
793 |
$0.00 |
| 91307 |
|
741 |
695 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
179 |
160 |
$0.00 |
| D1330 |
|
363 |
235 |
$0.00 |
| 91305 |
|
561 |
554 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
489 |
488 |
$0.00 |
| 91303 |
|
149 |
149 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
70 |
70 |
$0.00 |
| Q2039 |
Influenza virus vaccine, not otherwise specified |
478 |
477 |
$0.00 |
| 90674 |
|
280 |
280 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
14 |
14 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
13 |
12 |
$0.00 |
| 90710 |
|
1,446 |
1,446 |
$0.00 |
| 90633 |
|
5,362 |
5,361 |
$0.00 |
| 90648 |
|
2,409 |
2,409 |
$0.00 |
| 90700 |
|
1,822 |
1,821 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
42 |
41 |
$0.00 |
| 91311 |
|
128 |
126 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
2,496 |
2,494 |
$0.00 |
| 0502F |
|
295 |
237 |
$0.00 |
| 90685 |
|
791 |
789 |
$0.00 |
| 91313 |
|
856 |
856 |
$0.00 |
| 90671 |
|
76 |
76 |
$0.00 |
| 99408 |
|
357 |
348 |
$0.00 |
| 90661 |
|
223 |
223 |
$0.00 |
| D5422 |
|
51 |
25 |
$0.00 |
| 91300 |
|
1,034 |
975 |
$0.00 |
| 90687 |
|
13 |
13 |
$0.00 |
| MEDAD |
|
65 |
62 |
$0.00 |
| 91312 |
|
86 |
86 |
$0.00 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
35 |
35 |
$0.00 |