| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0100 |
Non-emergency transportation; taxi |
5,367,625 |
297,596 |
$187.60M |
| A0130 |
Non-emergency transportation: wheelchair van |
465,619 |
53,206 |
$39.67M |
| T2003 |
Non-emergency transportation; encounter/trip |
603,938 |
48,528 |
$11.08M |
| T1016 |
Case management, each 15 minutes |
62,833 |
17,661 |
$8.57M |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
242,712 |
226,253 |
$7.34M |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
5,583,065 |
122,850 |
$6.96M |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
5,747 |
1,403 |
$665K |
| S5145 |
Foster care, therapeutic, child; per diem |
26,949 |
8,978 |
$552K |
| A0090 |
Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest |
67,552 |
3,358 |
$383K |
| S5185 |
Medication reminder service, non-face-to-face; per month |
5,042 |
4,145 |
$279K |
| 99199 |
Unlisted special service, procedure or report |
4,140 |
2,949 |
$224K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,325 |
1,218 |
$195K |
| 97124 |
|
2,816 |
1,023 |
$128K |
| 1223Z |
|
2,412 |
2,101 |
$106K |
| D1110 |
Prophylaxis - adult |
3,380 |
3,226 |
$95K |
| S5160 |
Emergency response system; installation and testing |
1,656 |
1,534 |
$61K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
1,421 |
609 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,289 |
2,202 |
$43K |
| A0170 |
Transportation ancillary: parking fees, tolls, other |
5,653 |
376 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
2,342 |
2,249 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,160 |
$23K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
440 |
176 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
413 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
61 |
$760.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$520.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
14 |
$518.00 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
43 |
28 |
$330.00 |
| D0603 |
|
167 |
164 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
324 |
320 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
36 |
35 |
$0.00 |
| X0150 |
|
237 |
237 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
29 |
$0.00 |
| D0602 |
|
27 |
27 |
$0.00 |
| D1351 |
Sealant - per tooth |
59 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
209 |
206 |
$0.00 |
| D1999 |
|
98 |
96 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$0.00 |