| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,767 |
11,814 |
$2.45M |
| D1120 |
Prophylaxis - child |
2,307 |
2,110 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,413 |
3,098 |
$51K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,216 |
4,318 |
$48K |
| D1110 |
Prophylaxis - adult |
946 |
865 |
$44K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,215 |
5,166 |
$33K |
| 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 |
1,120 |
740 |
$13K |
| T1016 |
Case management, each 15 minutes |
54 |
40 |
$13K |
| D0274 |
Bitewings - four radiographic images |
379 |
355 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
301 |
261 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
165 |
130 |
$6K |
| D1330 |
|
2,021 |
1,830 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
255 |
239 |
$3K |
| D0272 |
Bitewings - two radiographic images |
147 |
123 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
560 |
481 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
45 |
36 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
141 |
118 |
$1K |
| 90686 |
|
137 |
125 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$884.52 |
| 90461 |
|
128 |
110 |
$669.30 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
21 |
14 |
$641.39 |
| 99215 |
Prolong outpt/office vis |
168 |
142 |
$620.50 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
99 |
94 |
$619.67 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
26 |
$408.59 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$402.12 |
| 92015 |
Determination of refractive state |
27 |
27 |
$337.77 |
| T1027 |
Family training and counseling for child development, per 15 minutes |
18 |
16 |
$255.00 |
| 36415 |
Collection of venous blood by venipuncture |
699 |
640 |
$218.61 |
| 85018 |
|
119 |
82 |
$168.53 |
| 99173 |
|
130 |
100 |
$115.00 |
| 36416 |
|
119 |
81 |
$71.10 |
| 90837 |
Psychotherapy, 53 minutes with patient |
107 |
84 |
$60.00 |
| 99000 |
|
137 |
116 |
$21.82 |
| 96127 |
|
59 |
31 |
$10.71 |
| 99072 |
|
12 |
12 |
$0.00 |