| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
83,582 |
54,982 |
$11.82M |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
1,492 |
757 |
$1.19M |
| D0999 |
Unspecified diagnostic procedure, by report |
5,039 |
3,868 |
$368K |
| 59514 |
|
144 |
88 |
$136K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
967 |
741 |
$23K |
| 99223 |
Prolong inpt eval add15 m |
406 |
249 |
$21K |
| 0012A |
|
342 |
340 |
$12K |
| 99235 |
|
200 |
125 |
$10K |
| 0011A |
|
409 |
401 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34,189 |
25,744 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
546 |
428 |
$4K |
| D1120 |
Prophylaxis - child |
738 |
689 |
$4K |
| 0001A |
|
92 |
90 |
$4K |
| D1110 |
Prophylaxis - adult |
177 |
92 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,583 |
3,574 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
817 |
$3K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
239 |
117 |
$3K |
| D0274 |
Bitewings - four radiographic images |
798 |
619 |
$3K |
| 76818 |
|
184 |
91 |
$3K |
| 96127 |
|
23,408 |
14,166 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
823 |
693 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
80 |
$2K |
| D1206 |
Topical application of fluoride varnish |
590 |
549 |
$2K |
| 0002A |
|
39 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
874 |
766 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
160 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,637 |
1,316 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
10,485 |
8,419 |
$1K |
| 59430 |
|
63 |
60 |
$1K |
| J7297 |
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
12 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
50 |
$832.95 |
| 54150 |
|
38 |
25 |
$775.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
518 |
400 |
$607.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,302 |
1,007 |
$561.00 |
| 0502F |
|
7,134 |
3,975 |
$485.10 |
| 90716 |
|
311 |
182 |
$474.35 |
| 0064A |
|
14 |
14 |
$421.40 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
28 |
12 |
$398.40 |
| Q3014 |
Telehealth originating site facility fee |
2,953 |
2,189 |
$385.60 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,373 |
1,106 |
$342.60 |
| 90723 |
|
1,431 |
988 |
$334.20 |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,562 |
1,604 |
$325.30 |
| 90677 |
|
475 |
462 |
$317.49 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,403 |
1,605 |
$297.91 |
| 90791 |
Psychiatric diagnostic evaluation |
538 |
354 |
$244.22 |
| 90837 |
Psychotherapy, 53 minutes with patient |
308 |
152 |
$205.26 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
342 |
270 |
$198.20 |
| 90656 |
|
228 |
225 |
$183.81 |
| 90633 |
|
1,135 |
776 |
$179.90 |
| 0503F |
|
517 |
453 |
$150.00 |
| 0500F |
|
884 |
701 |
$132.30 |
| 99384 |
|
178 |
87 |
$128.60 |
| 59025 |
Fetal non-stress test |
32 |
15 |
$110.60 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,804 |
844 |
$102.04 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,693 |
1,702 |
$96.43 |
| 81025 |
|
4,664 |
3,885 |
$92.88 |
| 97802 |
|
1,498 |
794 |
$90.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,235 |
1,034 |
$84.62 |
| 90734 |
|
416 |
288 |
$83.55 |
| 90696 |
|
207 |
158 |
$79.64 |
| 90686 |
|
1,149 |
826 |
$67.77 |
| 81002 |
|
4,515 |
2,982 |
$59.80 |
| 90710 |
|
269 |
194 |
$46.22 |
| 92551 |
|
2,249 |
1,696 |
$45.00 |
| 99173 |
|
3,783 |
2,893 |
$38.08 |
| 90620 |
|
154 |
140 |
$33.42 |
| 97803 |
|
1,128 |
488 |
$30.00 |
| 36415 |
Collection of venous blood by venipuncture |
6,683 |
4,486 |
$26.00 |
| G0008 |
Administration of influenza virus vaccine |
1,017 |
535 |
$19.20 |
| 90700 |
|
95 |
68 |
$7.00 |
| 99201 |
|
138 |
94 |
$3.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,225 |
1,078 |
$1.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,208 |
1,173 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,560 |
1,307 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,659 |
1,261 |
$0.00 |
| 90707 |
|
295 |
173 |
$0.00 |
| 90670 |
|
1,257 |
725 |
$0.00 |
| 99382 |
|
76 |
45 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,059 |
1,010 |
$0.00 |
| 3078F |
|
1,399 |
1,314 |
$0.00 |
| 3077F |
|
64 |
61 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
122 |
107 |
$0.00 |
| 90715 |
|
171 |
89 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$0.00 |
| 1159F |
|
12 |
12 |
$0.00 |
| 1160F |
|
12 |
12 |
$0.00 |
| 99383 |
|
331 |
176 |
$0.00 |
| 99386 |
|
68 |
68 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,298 |
933 |
$0.00 |
| 90651 |
|
377 |
219 |
$0.00 |
| 1125F |
|
251 |
242 |
$0.00 |
| 90680 |
|
556 |
367 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
12,085 |
10,227 |
$0.00 |
| 3075F |
|
197 |
191 |
$0.00 |
| 90647 |
|
455 |
245 |
$0.00 |
| 3080F |
|
60 |
57 |
$0.00 |
| 3079F |
|
451 |
441 |
$0.00 |
| 1126F |
|
1,876 |
1,741 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
114 |
113 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |
| 3074F |
|
1,647 |
1,538 |
$0.00 |
| 99381 |
|
204 |
190 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
54 |
53 |
$0.00 |
| 99385 |
|
116 |
94 |
$0.00 |
| 92587 |
|
16 |
12 |
$0.00 |