| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,194 |
17,405 |
$2.84M |
| D0999 |
Unspecified diagnostic procedure, by report |
3,876 |
1,905 |
$302K |
| H2020 |
Therapeutic behavioral services, per diem |
1,571 |
681 |
$158K |
| 99051 |
|
2,978 |
2,517 |
$31K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,838 |
12,524 |
$252.06 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,091 |
2,683 |
$234.83 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
560 |
$189.48 |
| 0012A |
|
27 |
13 |
$185.40 |
| D0330 |
Panoramic radiographic image |
845 |
534 |
$171.15 |
| D1110 |
Prophylaxis - adult |
362 |
243 |
$96.02 |
| D0140 |
Limited oral evaluation - problem focused |
479 |
251 |
$42.21 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
1,179 |
1,076 |
$24.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,126 |
613 |
$14.69 |
| 1159F |
|
1,492 |
1,314 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
828 |
498 |
$0.00 |
| 3078F |
|
276 |
241 |
$0.00 |
| 96160 |
|
16 |
16 |
$0.00 |
| 99173 |
|
68 |
64 |
$0.00 |
| 1160F |
|
1,467 |
1,294 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
688 |
605 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
255 |
231 |
$0.00 |
| 81003 |
|
142 |
112 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
576 |
279 |
$0.00 |
| 91300 |
|
59 |
12 |
$0.00 |
| 81025 |
|
83 |
63 |
$0.00 |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
12 |
12 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
13 |
13 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
24 |
12 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
19 |
19 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
20 |
15 |
$0.00 |
| 99000 |
|
1,225 |
979 |
$0.00 |
| 1034F |
|
526 |
446 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
539 |
496 |
$0.00 |
| D1330 |
|
793 |
457 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
3,046 |
2,556 |
$0.00 |
| 3008F |
|
6,727 |
5,562 |
$0.00 |
| 96127 |
|
5,466 |
4,417 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
458 |
362 |
$0.00 |
| 1125F |
|
886 |
787 |
$0.00 |
| D0603 |
|
592 |
317 |
$0.00 |
| 3074F |
|
362 |
304 |
$0.00 |
| 92551 |
|
70 |
66 |
$0.00 |
| 1035F |
|
114 |
94 |
$0.00 |
| 90686 |
|
170 |
150 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
39 |
38 |
$0.00 |
| 3079F |
|
177 |
150 |
$0.00 |
| 1036F |
|
962 |
826 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
628 |
212 |
$0.00 |
| 91301 |
|
73 |
34 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
440 |
220 |
$0.00 |
| 3075F |
|
65 |
58 |
$0.00 |
| 1126F |
|
608 |
536 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
178 |
153 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
140 |
126 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
399 |
163 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
60 |
32 |
$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 |
43 |
38 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
325 |
295 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
12 |
12 |
$0.00 |
| 90688 |
|
16 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |