| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,254 |
11,633 |
$1.90M |
| D0999 |
Unspecified diagnostic procedure, by report |
17,661 |
10,668 |
$1.57M |
| H2020 |
Therapeutic behavioral services, per diem |
2,459 |
1,123 |
$150K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,515 |
2,739 |
$29K |
| D0330 |
Panoramic radiographic image |
4,320 |
2,723 |
$16K |
| D1110 |
Prophylaxis - adult |
4,754 |
3,018 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,010 |
616 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
2,211 |
1,310 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,244 |
2,248 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,276 |
713 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
3,433 |
2,369 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,223 |
2,064 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,250 |
8,383 |
$570.00 |
| 3074F |
|
3,697 |
2,776 |
$420.02 |
| 3078F |
|
3,176 |
2,423 |
$305.01 |
| 3079F |
|
1,719 |
1,371 |
$280.02 |
| 90832 |
Psychotherapy, 30 minutes with patient |
620 |
385 |
$174.86 |
| 3077F |
|
656 |
512 |
$120.01 |
| 81003 |
|
1,151 |
926 |
$98.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
296 |
188 |
$86.94 |
| 96160 |
|
6,301 |
4,921 |
$45.00 |
| 3080F |
|
120 |
93 |
$30.00 |
| D0272 |
Bitewings - two radiographic images |
257 |
220 |
$21.43 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,463 |
1,281 |
$19.77 |
| 3075F |
|
631 |
516 |
$15.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,015 |
421 |
$0.02 |
| 1159F |
|
5,351 |
4,058 |
$0.01 |
| 1160F |
|
5,328 |
4,047 |
$0.01 |
| 1126F |
|
3,828 |
2,888 |
$0.01 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
69 |
60 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,609 |
2,179 |
$0.00 |
| 82947 |
|
368 |
309 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
820 |
683 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
138 |
108 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
314 |
246 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,024 |
927 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
48 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
72 |
37 |
$0.00 |
| D1999 |
|
123 |
115 |
$0.00 |
| D0180 |
|
16 |
14 |
$0.00 |
| 99173 |
|
18 |
13 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
18 |
13 |
$0.00 |
| 90756 |
|
19 |
16 |
$0.00 |
| 81025 |
|
35 |
31 |
$0.00 |
| 1158F |
|
15 |
13 |
$0.00 |
| 80305 |
|
45 |
19 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
14 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,042 |
2,443 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,041 |
882 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
67 |
60 |
$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 |
370 |
327 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
524 |
308 |
$0.00 |
| 1125F |
|
1,349 |
1,145 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
217 |
190 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
102 |
87 |
$0.00 |
| 00000 |
|
12 |
12 |
$0.00 |
| 91301 |
|
117 |
52 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
57 |
19 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
104 |
82 |
$0.00 |
| 90686 |
|
35 |
28 |
$0.00 |
| 1111F |
|
36 |
27 |
$0.00 |
| 82043 |
|
28 |
24 |
$0.00 |
| D1351 |
Sealant - per tooth |
18 |
12 |
$0.00 |
| 0012A |
|
26 |
12 |
$0.00 |
| 0011A |
|
28 |
12 |
$0.00 |
| 1170F |
|
15 |
13 |
$0.00 |
| 3044F |
|
20 |
13 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
22 |
16 |
$0.00 |