| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
65,794 |
46,047 |
$7.57M |
| D0999 |
Unspecified diagnostic procedure, by report |
26,841 |
23,291 |
$2.43M |
| D0120 |
Periodic oral evaluation - established patient |
7,524 |
7,344 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,492 |
4,509 |
$27K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
347 |
224 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
3,650 |
3,487 |
$23K |
| D0272 |
Bitewings - two radiographic images |
3,486 |
3,409 |
$22K |
| D1120 |
Prophylaxis - child |
1,715 |
1,675 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33,941 |
26,051 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
898 |
823 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,196 |
1,051 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,284 |
2,201 |
$10K |
| D0330 |
Panoramic radiographic image |
3,200 |
3,136 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12,601 |
9,434 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,522 |
2,086 |
$5K |
| D2330 |
|
278 |
236 |
$2K |
| D1110 |
Prophylaxis - adult |
331 |
313 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
26 |
$1K |
| 0502F |
|
371 |
142 |
$963.28 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,035 |
943 |
$793.18 |
| 90834 |
Psychotherapy, 45 minutes with patient |
858 |
560 |
$707.20 |
| 0012A |
|
19 |
19 |
$553.16 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
806 |
692 |
$441.50 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
853 |
766 |
$391.66 |
| 81002 |
|
2,256 |
1,604 |
$382.60 |
| 0011A |
|
17 |
17 |
$287.98 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
602 |
522 |
$252.90 |
| 90688 |
|
543 |
466 |
$176.96 |
| D1206 |
Topical application of fluoride varnish |
1,637 |
1,589 |
$112.72 |
| 81025 |
|
1,126 |
879 |
$82.28 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
258 |
171 |
$64.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
849 |
727 |
$58.34 |
| 80305 |
|
648 |
572 |
$53.40 |
| 90710 |
|
141 |
130 |
$16.71 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
224 |
210 |
$15.65 |
| 3077F |
|
1,442 |
1,349 |
$0.00 |
| 90461 |
|
223 |
217 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
1,372 |
1,281 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
373 |
317 |
$0.00 |
| 3078F |
|
6,967 |
6,377 |
$0.00 |
| 4004F |
|
438 |
417 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
178 |
97 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
9,722 |
8,734 |
$0.00 |
| 90633 |
|
33 |
31 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
625 |
599 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
25 |
$0.00 |
| 1159F |
|
648 |
612 |
$0.00 |
| 90734 |
|
41 |
37 |
$0.00 |
| D2140 |
|
42 |
39 |
$0.00 |
| 90715 |
|
53 |
48 |
$0.00 |
| M1016 |
Female patients unable to bear children |
35 |
30 |
$0.00 |
| D2940 |
|
35 |
24 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
79 |
64 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
24 |
12 |
$0.00 |
| D1354 |
|
19 |
12 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
37 |
26 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
941 |
844 |
$0.00 |
| 3075F |
|
1,892 |
1,782 |
$0.00 |
| 3044F |
|
85 |
79 |
$0.00 |
| 90651 |
|
72 |
67 |
$0.00 |
| 80100 |
|
50 |
27 |
$0.00 |
| 3079F |
|
3,712 |
3,438 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
9,929 |
8,917 |
$0.00 |
| 3008F |
|
12,572 |
11,028 |
$0.00 |
| D0603 |
|
143 |
127 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
1,165 |
1,083 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
2,315 |
2,156 |
$0.00 |
| 2001F |
|
2,153 |
1,907 |
$0.00 |
| 3080F |
|
180 |
170 |
$0.00 |
| D0601 |
|
161 |
157 |
$0.00 |
| 3074F |
|
7,994 |
7,274 |
$0.00 |
| 1036F |
|
7,388 |
6,604 |
$0.00 |
| 99383 |
|
40 |
38 |
$0.00 |
| 99384 |
|
56 |
55 |
$0.00 |
| 86580 |
|
19 |
15 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
262 |
$0.00 |
| 96127 |
|
145 |
137 |
$0.00 |
| D2331 |
|
31 |
26 |
$0.00 |
| 1126F |
|
24 |
24 |
$0.00 |
| 90619 |
|
33 |
31 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$0.00 |
| D2335 |
|
17 |
16 |
$0.00 |
| D0602 |
|
62 |
59 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
146 |
$0.00 |
| 1125F |
|
33 |
30 |
$0.00 |
| 1170F |
|
56 |
51 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
30 |
12 |
$0.00 |
| 90696 |
|
15 |
15 |
$0.00 |