| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
18,621 |
16,297 |
$2.03M |
| T1015 |
Clinic visit/encounter, all-inclusive |
20,626 |
12,560 |
$1.84M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
4,896 |
2,850 |
$364K |
| 99000 |
|
934 |
836 |
$22K |
| D1120 |
Prophylaxis - child |
5,418 |
5,180 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
3,677 |
3,412 |
$6K |
| D1110 |
Prophylaxis - adult |
2,130 |
1,946 |
$4K |
| 90837 |
Psychotherapy, 53 minutes with patient |
839 |
561 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,861 |
2,175 |
$2K |
| D0330 |
Panoramic radiographic image |
3,768 |
3,621 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,720 |
1,323 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
7,816 |
4,417 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,173 |
1,398 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
238 |
193 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,832 |
3,105 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,512 |
1,219 |
$993.60 |
| 90791 |
Psychiatric diagnostic evaluation |
1,408 |
1,196 |
$791.24 |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,316 |
3,032 |
$719.26 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,048 |
2,889 |
$573.05 |
| D0120 |
Periodic oral evaluation - established patient |
5,177 |
4,915 |
$331.20 |
| D0274 |
Bitewings - four radiographic images |
3,481 |
3,332 |
$220.80 |
| D0220 |
Intraoral - periapical first radiographic image |
3,420 |
3,147 |
$116.00 |
| 82947 |
|
58 |
46 |
$19.10 |
| D0272 |
Bitewings - two radiographic images |
2,824 |
2,690 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
285 |
231 |
$0.00 |
| D1351 |
Sealant - per tooth |
904 |
314 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
5,195 |
4,960 |
$0.00 |
| D0601 |
|
189 |
189 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
416 |
357 |
$0.00 |
| D2335 |
|
40 |
24 |
$0.00 |
| D0602 |
|
126 |
126 |
$0.00 |
| 99383 |
|
45 |
26 |
$0.00 |
| 99406 |
|
20 |
18 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
17 |
16 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
18 |
14 |
$0.00 |
| 85018 |
|
33 |
33 |
$0.00 |
| D2330 |
|
35 |
25 |
$0.00 |
| D0603 |
|
20 |
20 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
76 |
67 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
229 |
224 |
$0.00 |
| D2394 |
|
26 |
24 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
28 |
28 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
94 |
72 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
43 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
40 |
27 |
$0.00 |
| D2332 |
|
18 |
12 |
$0.00 |