| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
100,727 |
72,258 |
$6.19M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21,560 |
14,996 |
$305K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
39,041 |
30,304 |
$147K |
| 90834 |
Psychotherapy, 45 minutes with patient |
7,285 |
4,172 |
$91K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,472 |
1,997 |
$34K |
| 90837 |
Psychotherapy, 53 minutes with patient |
572 |
309 |
$21K |
| 90791 |
Psychiatric diagnostic evaluation |
850 |
600 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,507 |
3,533 |
$13K |
| D0330 |
Panoramic radiographic image |
2,382 |
1,639 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,581 |
952 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,176 |
630 |
$10K |
| D1110 |
Prophylaxis - adult |
3,233 |
2,289 |
$10K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,035 |
853 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
980 |
665 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
1,421 |
1,197 |
$6K |
| 97803 |
|
290 |
186 |
$5K |
| 99441 |
|
4,927 |
3,554 |
$5K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
131 |
77 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
1,483 |
1,009 |
$4K |
| D0274 |
Bitewings - four radiographic images |
2,242 |
1,588 |
$3K |
| D1120 |
Prophylaxis - child |
1,608 |
1,101 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
796 |
627 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,269 |
783 |
$2K |
| D1206 |
Topical application of fluoride varnish |
528 |
348 |
$2K |
| T2003 |
Non-emergency transportation; encounter/trip |
1,574 |
1,009 |
$1K |
| 99442 |
|
115 |
73 |
$837.87 |
| 97802 |
|
21 |
12 |
$751.44 |
| D1351 |
Sealant - per tooth |
883 |
135 |
$693.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
150 |
126 |
$620.89 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
191 |
129 |
$465.12 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
725 |
583 |
$383.15 |
| D2330 |
|
120 |
78 |
$376.39 |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
191 |
$351.64 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
393 |
347 |
$103.60 |
| 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 |
358 |
273 |
$52.48 |
| D0272 |
Bitewings - two radiographic images |
321 |
309 |
$30.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
13 |
$25.50 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
19 |
12 |
$9.93 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
325 |
269 |
$4.66 |
| 3077F |
|
373 |
267 |
$0.06 |
| 3079F |
|
1,380 |
1,002 |
$0.04 |
| 3074F |
|
2,687 |
1,960 |
$0.03 |
| 3078F |
|
2,146 |
1,562 |
$0.03 |
| 3075F |
|
287 |
192 |
$0.01 |
| 90688 |
|
174 |
144 |
$0.00 |
| 3080F |
|
114 |
92 |
$0.00 |
| 90686 |
|
54 |
42 |
$0.00 |
| D0603 |
|
109 |
84 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
366 |
269 |
$0.00 |
| 99406 |
|
25 |
24 |
$0.00 |
| 98925 |
|
12 |
12 |
$0.00 |
| D2331 |
|
33 |
27 |
$0.00 |
| 0064A |
|
14 |
13 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
18 |
13 |
$0.00 |
| 91306 |
|
14 |
13 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
33 |
15 |
$0.00 |
| D0601 |
|
14 |
13 |
$0.00 |
| 1160F |
|
5,638 |
4,068 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
55 |
$0.00 |
| 81025 |
|
57 |
49 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
213 |
189 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
90 |
82 |
$0.00 |
| 90658 |
|
39 |
31 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
58 |
51 |
$0.00 |
| 81003 |
|
145 |
125 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
74 |
65 |
$0.00 |
| 90649 |
|
13 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
40 |
40 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
125 |
102 |
$0.00 |
| 90734 |
|
17 |
16 |
$0.00 |
| 90715 |
|
13 |
12 |
$0.00 |
| 90700 |
|
13 |
12 |
$0.00 |