| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
86,258 |
54,411 |
$10.01M |
| D0999 |
Unspecified diagnostic procedure, by report |
20,819 |
17,653 |
$2.32M |
| 0071A |
|
276 |
263 |
$12K |
| 0072A |
|
264 |
251 |
$11K |
| 0064A |
|
149 |
149 |
$6K |
| 0002A |
|
144 |
102 |
$6K |
| 0001A |
|
103 |
81 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
51,358 |
33,112 |
$4K |
| 90658 |
|
2,377 |
1,407 |
$3K |
| 0003A |
|
52 |
50 |
$2K |
| 0054A |
|
48 |
43 |
$2K |
| 0011A |
|
99 |
97 |
$2K |
| 0004A |
|
36 |
35 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,200 |
4,678 |
$1K |
| 90649 |
|
525 |
353 |
$949.25 |
| 90710 |
|
298 |
223 |
$924.76 |
| 90670 |
|
2,365 |
1,947 |
$815.93 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,968 |
2,387 |
$340.60 |
| 90633 |
|
1,014 |
789 |
$334.10 |
| 90734 |
|
601 |
435 |
$327.70 |
| 90686 |
|
904 |
874 |
$280.26 |
| 90696 |
|
254 |
189 |
$235.90 |
| 90688 |
|
672 |
651 |
$218.02 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,691 |
2,268 |
$208.70 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,169 |
3,351 |
$199.87 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,676 |
2,254 |
$193.84 |
| 90723 |
|
1,374 |
1,202 |
$176.80 |
| 90715 |
|
634 |
473 |
$169.77 |
| 99173 |
|
2,561 |
2,140 |
$161.90 |
| 92551 |
|
2,497 |
2,096 |
$161.20 |
| 90707 |
|
285 |
165 |
$159.08 |
| 90716 |
|
316 |
193 |
$140.04 |
| 90680 |
|
1,589 |
1,336 |
$138.20 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,255 |
1,146 |
$123.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,848 |
1,773 |
$106.32 |
| 81025 |
|
821 |
570 |
$104.66 |
| 90648 |
|
795 |
747 |
$103.80 |
| 36415 |
Collection of venous blood by venipuncture |
2,789 |
2,146 |
$97.10 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,116 |
1,562 |
$96.00 |
| 90791 |
Psychiatric diagnostic evaluation |
439 |
307 |
$91.58 |
| 90647 |
|
1,028 |
810 |
$74.23 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,621 |
1,388 |
$71.00 |
| 90461 |
|
1,891 |
1,546 |
$66.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,456 |
3,456 |
$64.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,341 |
1,672 |
$61.70 |
| 90657 |
|
779 |
490 |
$44.80 |
| 85018 |
|
601 |
385 |
$44.32 |
| 81002 |
|
781 |
568 |
$44.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,240 |
2,987 |
$42.10 |
| 90651 |
|
280 |
263 |
$41.40 |
| 99383 |
|
319 |
164 |
$35.15 |
| 90832 |
Psychotherapy, 30 minutes with patient |
996 |
657 |
$29.48 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
246 |
224 |
$22.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
528 |
363 |
$19.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
274 |
162 |
$15.70 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
132 |
124 |
$14.00 |
| 82962 |
|
640 |
410 |
$13.65 |
| 90698 |
|
338 |
216 |
$12.80 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
41 |
41 |
$12.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,816 |
1,661 |
$11.20 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
329 |
234 |
$10.00 |
| 99201 |
|
26 |
26 |
$9.00 |
| 99381 |
|
779 |
678 |
$8.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
290 |
257 |
$7.00 |
| 76801 |
|
200 |
119 |
$1.00 |
| D0120 |
Periodic oral evaluation - established patient |
9,475 |
8,836 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,379 |
1,275 |
$0.00 |
| D0603 |
|
6,243 |
5,756 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
304 |
260 |
$0.00 |
| D0601 |
|
3,537 |
3,242 |
$0.00 |
| 93000 |
|
150 |
93 |
$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 |
168 |
146 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
771 |
468 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
3,234 |
3,034 |
$0.00 |
| 99386 |
|
49 |
39 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,619 |
3,293 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
7,122 |
6,770 |
$0.00 |
| 3074F |
|
397 |
334 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,126 |
1,006 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
132 |
100 |
$0.00 |
| 99384 |
|
262 |
114 |
$0.00 |
| 3075F |
|
102 |
84 |
$0.00 |
| 4010F |
|
74 |
72 |
$0.00 |
| 3008F |
|
584 |
504 |
$0.00 |
| D0602 |
|
1,151 |
990 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
126 |
105 |
$0.00 |
| 81005 |
|
39 |
39 |
$0.00 |
| 86580 |
|
27 |
13 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
14 |
$0.00 |
| 3044F |
|
15 |
14 |
$0.00 |
| 3079F |
|
186 |
152 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
103 |
27 |
$0.00 |
| 96127 |
|
75 |
73 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
41 |
41 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
19 |
12 |
$0.00 |
| 99385 |
|
124 |
70 |
$0.00 |
| 0503F |
|
28 |
12 |
$0.00 |
| 3080F |
|
34 |
30 |
$0.00 |
| 1036F |
|
135 |
128 |
$0.00 |
| 94760 |
|
39 |
28 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
92 |
$0.00 |
| 90474 |
|
16 |
16 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
50 |
$0.00 |
| 90619 |
|
57 |
57 |
$0.00 |
| 58300 |
|
16 |
13 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
473 |
247 |
$0.00 |
| D1120 |
Prophylaxis - child |
11,142 |
10,445 |
$0.00 |
| 3078F |
|
429 |
365 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,812 |
2,584 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
465 |
316 |
$0.00 |
| D1110 |
Prophylaxis - adult |
281 |
250 |
$0.00 |
| D0180 |
|
141 |
111 |
$0.00 |
| D1354 |
|
109 |
61 |
$0.00 |
| 3046F |
|
14 |
13 |
$0.00 |
| 90700 |
|
252 |
166 |
$0.00 |
| 3077F |
|
165 |
147 |
$0.00 |
| 99382 |
|
121 |
49 |
$0.00 |
| 1159F |
|
74 |
68 |
$0.00 |
| D0270 |
|
91 |
90 |
$0.00 |
| 83026 |
|
114 |
95 |
$0.00 |
| 0502F |
|
64 |
46 |
$0.00 |
| 1160F |
|
53 |
53 |
$0.00 |