| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9450 |
|
43,009 |
22,935 |
$1.07M |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,938 |
1,743 |
$321K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,229 |
1,943 |
$247K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,556 |
625 |
$215K |
| D0140 |
Limited oral evaluation - problem focused |
9,168 |
5,111 |
$196K |
| D1110 |
Prophylaxis - adult |
7,898 |
5,659 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,857 |
2,697 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,582 |
1,066 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
4,259 |
3,019 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,794 |
2,315 |
$109K |
| D0330 |
Panoramic radiographic image |
2,934 |
1,696 |
$105K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,129 |
1,776 |
$93K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,796 |
1,618 |
$79K |
| D0274 |
Bitewings - four radiographic images |
4,785 |
3,382 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
7,114 |
5,066 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
6,711 |
3,722 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
462 |
205 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,470 |
2,366 |
$45K |
| D9110 |
|
1,383 |
845 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
901 |
576 |
$29K |
| D2331 |
|
837 |
375 |
$25K |
| D0180 |
|
1,738 |
1,017 |
$24K |
| 90791 |
Psychiatric diagnostic evaluation |
178 |
175 |
$23K |
| 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 |
635 |
520 |
$23K |
| D1206 |
Topical application of fluoride varnish |
810 |
762 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
38 |
37 |
$16K |
| D2330 |
|
618 |
236 |
$16K |
| D1120 |
Prophylaxis - child |
248 |
241 |
$12K |
| G0469 |
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new 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 |
84 |
84 |
$11K |
| D0270 |
|
1,826 |
1,278 |
$11K |
| 99050 |
|
209 |
201 |
$11K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
324 |
298 |
$10K |
| D3320 |
|
45 |
36 |
$10K |
| 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 |
218 |
144 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
368 |
139 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
48 |
46 |
$2K |
| D2332 |
|
42 |
25 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
27 |
$1K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
17 |
17 |
$872.27 |
| D2335 |
|
21 |
13 |
$855.00 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
17 |
17 |
$398.82 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
155 |
145 |
$346.79 |
| D0272 |
Bitewings - two radiographic images |
17 |
13 |
$328.00 |
| 92015 |
Determination of refractive state |
28 |
28 |
$312.22 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
71 |
70 |
$230.92 |
| 90686 |
|
13 |
13 |
$190.30 |
| D4341 |
|
1,730 |
196 |
$125.00 |
| D0350 |
|
85 |
44 |
$0.00 |
| D0460 |
|
57 |
43 |
$0.00 |
| D9995 |
|
1,438 |
789 |
$0.00 |
| 90674 |
|
21 |
21 |
$0.00 |
| 91301 |
|
14 |
12 |
$0.00 |