| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
47,359 |
40,712 |
$4.08M |
| 00003 |
Internal/system code - not a standard HCPCS code |
2,919 |
2,738 |
$368K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,472 |
1,932 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
748 |
688 |
$12K |
| 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 |
175 |
152 |
$10K |
| S5102 |
Day care services, adult; per diem |
168 |
21 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
77 |
77 |
$3K |
| 92551 |
|
348 |
348 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
118 |
113 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
42 |
42 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
41 |
41 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
25 |
25 |
$849.14 |
| 90791 |
Psychiatric diagnostic evaluation |
52 |
52 |
$750.00 |
| 90686 |
|
116 |
115 |
$631.00 |
| 99381 |
|
12 |
12 |
$530.40 |
| 90670 |
|
35 |
35 |
$315.90 |
| 90647 |
|
28 |
28 |
$225.90 |
| 90723 |
|
28 |
28 |
$216.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
203 |
$184.00 |
| 90633 |
|
12 |
12 |
$108.00 |
| 81025 |
|
25 |
25 |
$36.01 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$33.96 |
| 85018 |
|
77 |
75 |
$31.00 |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
520 |
$24.00 |
| 81002 |
|
29 |
29 |
$23.02 |
| D0210 |
Intraoral - complete series of radiographic images |
163 |
125 |
$0.00 |
| D0603 |
|
625 |
520 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
308 |
269 |
$0.00 |
| D1330 |
|
514 |
442 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
448 |
383 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
518 |
466 |
$0.00 |
| 3008F |
|
871 |
847 |
$0.00 |
| 99172 |
|
43 |
43 |
$0.00 |
| 90657 |
|
15 |
15 |
$0.00 |
| 97802 |
|
137 |
137 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
137 |
137 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
55 |
54 |
$0.00 |
| D1310 |
|
16 |
14 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
43 |
$0.00 |
| 3074F |
|
103 |
98 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
184 |
152 |
$0.00 |
| D1110 |
Prophylaxis - adult |
96 |
73 |
$0.00 |
| D0270 |
|
15 |
15 |
$0.00 |
| D1120 |
Prophylaxis - child |
171 |
155 |
$0.00 |
| 99173 |
|
177 |
177 |
$0.00 |
| 99401 |
|
137 |
137 |
$0.00 |
| 3078F |
|
60 |
59 |
$0.00 |
| D4341 |
|
38 |
13 |
$0.00 |
| D9430 |
|
15 |
12 |
$0.00 |