| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9450 |
|
104,700 |
63,042 |
$3.53M |
| T1015 |
Clinic visit/encounter, all-inclusive |
59,775 |
51,662 |
$3.23M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
15,791 |
11,093 |
$2.17M |
| 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 |
34,161 |
29,688 |
$1.51M |
| 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 |
8,981 |
7,561 |
$1.34M |
| 90834 |
Psychotherapy, 45 minutes with patient |
13,800 |
9,917 |
$1.08M |
| D1110 |
Prophylaxis - adult |
28,587 |
20,704 |
$919K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,463 |
4,394 |
$588K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
25,266 |
23,979 |
$466K |
| D0274 |
Bitewings - four radiographic images |
18,245 |
14,316 |
$439K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,234 |
5,922 |
$435K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,112 |
1,976 |
$425K |
| D0210 |
Intraoral - complete series of radiographic images |
10,843 |
7,423 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
26,843 |
20,316 |
$412K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,090 |
5,806 |
$409K |
| D0140 |
Limited oral evaluation - problem focused |
13,720 |
8,656 |
$334K |
| 90677 |
|
1,697 |
1,692 |
$319K |
| D5212 |
|
1,171 |
723 |
$318K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,693 |
8,027 |
$280K |
| D1120 |
Prophylaxis - child |
5,135 |
5,023 |
$255K |
| D1351 |
Sealant - per tooth |
6,738 |
1,864 |
$253K |
| D0330 |
Panoramic radiographic image |
5,841 |
4,303 |
$252K |
| D4341 |
|
4,845 |
1,570 |
$237K |
| D0180 |
|
11,196 |
8,394 |
$231K |
| D5211 |
|
952 |
583 |
$222K |
| D1206 |
Topical application of fluoride varnish |
6,671 |
6,499 |
$167K |
| D0220 |
Intraoral - periapical first radiographic image |
17,459 |
11,100 |
$165K |
| D2331 |
|
3,088 |
1,873 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,984 |
2,023 |
$155K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
492 |
290 |
$144K |
| 90739 |
|
1,411 |
1,397 |
$142K |
| D2330 |
|
3,143 |
1,619 |
$138K |
| 90791 |
Psychiatric diagnostic evaluation |
1,130 |
1,128 |
$135K |
| D2335 |
|
1,321 |
783 |
$107K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,236 |
2,055 |
$103K |
| D2332 |
|
1,195 |
698 |
$78K |
| 91320 |
|
708 |
708 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,683 |
2,377 |
$64K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,544 |
22,661 |
$59K |
| D9110 |
|
2,893 |
1,503 |
$58K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,495 |
2,464 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,169 |
3,518 |
$56K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
5,757 |
5,558 |
$54K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,130 |
2,946 |
$52K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
6,739 |
5,905 |
$50K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,231 |
1,101 |
$47K |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
2,655 |
2,575 |
$47K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
1,523 |
761 |
$46K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
557 |
533 |
$44K |
| 90715 |
|
1,790 |
1,783 |
$42K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
1,334 |
1,301 |
$41K |
| 90686 |
|
3,726 |
3,615 |
$41K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,290 |
1,063 |
$40K |
| 90673 |
|
817 |
817 |
$39K |
| 90480 |
|
895 |
894 |
$39K |
| D2740 |
Crown - porcelain/ceramic |
72 |
59 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
570 |
361 |
$37K |
| 91322 |
|
262 |
262 |
$36K |
| 99381 |
|
227 |
226 |
$35K |
| 90837 |
Psychotherapy, 53 minutes with patient |
396 |
335 |
$34K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,509 |
1,271 |
$33K |
| D0270 |
|
3,805 |
2,579 |
$29K |
| 92551 |
|
2,721 |
2,719 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
783 |
771 |
$24K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,027 |
1,025 |
$23K |
| 99385 |
|
379 |
379 |
$22K |
| D1354 |
|
1,571 |
411 |
$20K |
| 97803 |
|
2,013 |
1,883 |
$19K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
893 |
832 |
$19K |
| 0012A |
|
416 |
416 |
$18K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,704 |
4,616 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
877 |
876 |
$16K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
716 |
705 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
921 |
920 |
$14K |
| 0011A |
|
450 |
450 |
$13K |
| 87634 |
|
205 |
203 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,735 |
5,516 |
$12K |
| 82947 |
|
4,890 |
4,400 |
$12K |
| 90732 |
|
103 |
103 |
$11K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
99 |
93 |
$9K |
| 99188 |
|
343 |
343 |
$9K |
| D5110 |
|
12 |
12 |
$9K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
636 |
625 |
$8K |
| 97802 |
|
283 |
282 |
$8K |
| 90670 |
|
186 |
185 |
$7K |
| 81025 |
|
977 |
945 |
$7K |
| 99173 |
|
2,630 |
2,628 |
$6K |
| 90746 |
|
121 |
118 |
$6K |
| 90707 |
|
431 |
430 |
$6K |
| D2394 |
|
106 |
59 |
$6K |
| 93000 |
|
352 |
346 |
$5K |
| 81002 |
|
1,948 |
1,897 |
$5K |
| 99383 |
|
252 |
251 |
$5K |
| 83037 |
|
644 |
626 |
$5K |
| 99384 |
|
185 |
185 |
$4K |
| 99205 |
Prolong outpt/office vis |
28 |
28 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
344 |
338 |
$4K |
| 90750 |
|
1,124 |
1,090 |
$4K |
| 0002A |
|
74 |
73 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
28 |
28 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
310 |
291 |
$3K |
| 0001A |
|
73 |
72 |
$3K |
| 90662 |
|
560 |
471 |
$3K |
| 0124A |
|
69 |
69 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
13 |
$3K |
| 97804 |
|
237 |
169 |
$3K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
574 |
572 |
$3K |
| D2140 |
|
66 |
38 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
401 |
399 |
$2K |
| 90636 |
|
15 |
15 |
$2K |
| D5650 |
|
70 |
24 |
$2K |
| 99382 |
|
75 |
75 |
$2K |
| D2950 |
|
23 |
17 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
159 |
149 |
$1K |
| 90713 |
|
345 |
343 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,303 |
1,284 |
$1K |
| 90649 |
|
48 |
48 |
$1K |
| 0064A |
|
24 |
24 |
$1K |
| 0121A |
|
40 |
40 |
$1K |
| 80305 |
|
193 |
93 |
$987.52 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$874.06 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
784 |
754 |
$853.07 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
2,618 |
2,563 |
$813.28 |
| 0134A |
|
28 |
26 |
$715.50 |
| D4346 |
|
15 |
14 |
$707.00 |
| 90714 |
|
28 |
28 |
$702.80 |
| D1330 |
|
581 |
469 |
$700.00 |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face 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 fqhc visit |
13 |
13 |
$576.29 |
| D3120 |
|
18 |
14 |
$518.00 |
| 0004A |
|
12 |
12 |
$458.73 |
| 82962 |
|
3,356 |
3,007 |
$322.55 |
| G0008 |
Administration of influenza virus vaccine |
518 |
433 |
$273.30 |
| 86580 |
|
45 |
44 |
$271.80 |
| 85018 |
|
105 |
104 |
$240.80 |
| 96127 |
|
137 |
137 |
$236.21 |
| D5422 |
|
50 |
44 |
$230.40 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$60.00 |
| D0170 |
|
25 |
20 |
$43.20 |
| 91313 |
|
162 |
148 |
$0.01 |
| 90619 |
|
551 |
551 |
$0.00 |
| 90696 |
|
170 |
170 |
$0.00 |
| 91306 |
|
50 |
50 |
$0.00 |
| 91315 |
|
55 |
55 |
$0.00 |
| 90716 |
|
494 |
493 |
$0.00 |
| 91319 |
|
73 |
73 |
$0.00 |
| 90680 |
|
396 |
395 |
$0.00 |
| 90744 |
|
505 |
504 |
$0.00 |
| 90620 |
|
120 |
120 |
$0.00 |
| 90698 |
|
551 |
549 |
$0.00 |
| D1352 |
|
166 |
39 |
$0.00 |
| 91301 |
|
608 |
602 |
$0.00 |
| 90651 |
|
1,102 |
1,099 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
27 |
27 |
$0.00 |
| D3310 |
|
52 |
37 |
$0.00 |
| 90697 |
|
194 |
194 |
$0.00 |
| 90381 |
|
14 |
14 |
$0.00 |
| 91318 |
|
13 |
13 |
$0.00 |
| 91307 |
|
16 |
16 |
$0.00 |
| 90710 |
|
244 |
243 |
$0.00 |
| D1999 |
|
28,151 |
16,228 |
$0.00 |
| 90633 |
|
896 |
894 |
$0.00 |
| 91300 |
|
291 |
254 |
$0.00 |
| 90700 |
|
144 |
143 |
$0.00 |
| 91312 |
|
250 |
238 |
$0.00 |
| 90671 |
|
291 |
291 |
$0.00 |
| 90734 |
|
56 |
56 |
$0.00 |
| 92081 |
|
145 |
145 |
$0.00 |
| 90648 |
|
70 |
70 |
$0.00 |
| 90681 |
|
27 |
27 |
$0.00 |
| 91321 |
|
12 |
12 |
$0.00 |