| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
62,971 |
44,070 |
$6.27M |
| D0999 |
Unspecified diagnostic procedure, by report |
10,045 |
3,429 |
$455K |
| H2020 |
Therapeutic behavioral services, per diem |
5,421 |
2,475 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,673 |
423 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,092 |
946 |
$4K |
| D1110 |
Prophylaxis - adult |
1,881 |
890 |
$4K |
| D0330 |
Panoramic radiographic image |
3,381 |
988 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
1,048 |
568 |
$3K |
| D0274 |
Bitewings - four radiographic images |
3,233 |
853 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
1,664 |
741 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,311 |
5,778 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
774 |
226 |
$772.33 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
65 |
$695.86 |
| 99215 |
Prolong outpt/office vis |
296 |
203 |
$509.58 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33,734 |
23,648 |
$442.56 |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
226 |
$405.85 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
12 |
$82.14 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,699 |
1,967 |
$42.63 |
| 90674 |
|
1,297 |
928 |
$29.94 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,527 |
3,912 |
$24.84 |
| J3490 |
Unclassified drugs |
198 |
132 |
$0.02 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
5,377 |
3,802 |
$0.00 |
| 86780 |
|
6,677 |
4,481 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,706 |
445 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
729 |
413 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
550 |
393 |
$0.00 |
| 3008F |
|
804 |
455 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
159 |
96 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
631 |
337 |
$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 |
16 |
15 |
$0.00 |
| 90686 |
|
388 |
307 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
459 |
213 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
212 |
111 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
77 |
37 |
$0.00 |
| 86803 |
|
14 |
12 |
$0.00 |
| 90694 |
|
50 |
23 |
$0.00 |
| 99407 |
|
20 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
31 |
24 |
$0.00 |
| 91300 |
|
372 |
211 |
$0.00 |
| 3085F |
|
534 |
179 |
$0.00 |
| 87210 |
|
675 |
453 |
$0.00 |
| 0124A |
|
117 |
91 |
$0.00 |
| 90461 |
|
51 |
38 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
511 |
246 |
$0.00 |
| 86703 |
|
1,430 |
1,083 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
259 |
193 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
661 |
313 |
$0.00 |
| 99173 |
|
21 |
13 |
$0.00 |
| 80305 |
|
396 |
150 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
313 |
117 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
15 |
12 |
$0.00 |
| 91312 |
|
146 |
113 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
233 |
137 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
130 |
44 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
133 |
108 |
$0.00 |
| 0003A |
|
37 |
26 |
$0.00 |
| 0004A |
|
18 |
16 |
$0.00 |
| 90749 |
|
16 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
12 |
$0.00 |
| 90611 |
|
14 |
13 |
$0.00 |
| 92552 |
|
18 |
12 |
$0.00 |