| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
62,089 |
44,577 |
$8.02M |
| D0999 |
Unspecified diagnostic procedure, by report |
11,725 |
10,404 |
$1.39M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,940 |
1,098 |
$134K |
| 90651 |
|
2,149 |
1,601 |
$27K |
| 90620 |
|
1,080 |
846 |
$12K |
| 90734 |
|
1,432 |
999 |
$12K |
| 90710 |
|
885 |
613 |
$8K |
| 90670 |
|
4,503 |
3,317 |
$4K |
| 90633 |
|
3,363 |
2,404 |
$4K |
| 90686 |
|
7,423 |
5,979 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,215 |
8,966 |
$3K |
| 90716 |
|
1,163 |
837 |
$3K |
| 90698 |
|
3,052 |
2,169 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
10,962 |
8,304 |
$2K |
| 90696 |
|
880 |
618 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,337 |
9,508 |
$2K |
| 90715 |
|
996 |
735 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,575 |
3,601 |
$1K |
| 90685 |
|
560 |
452 |
$974.40 |
| 90707 |
|
1,043 |
746 |
$914.60 |
| 90832 |
Psychotherapy, 30 minutes with patient |
7,705 |
4,090 |
$851.22 |
| 90744 |
|
2,017 |
1,456 |
$739.78 |
| 90680 |
|
1,909 |
1,371 |
$541.02 |
| 0502F |
|
1,588 |
1,137 |
$352.80 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,392 |
1,244 |
$213.80 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,707 |
3,812 |
$200.31 |
| 99381 |
|
708 |
646 |
$183.80 |
| D1351 |
Sealant - per tooth |
457 |
301 |
$141.12 |
| 90700 |
|
404 |
298 |
$138.40 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
53 |
41 |
$124.80 |
| 90791 |
Psychiatric diagnostic evaluation |
975 |
775 |
$106.58 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
213 |
146 |
$100.80 |
| D1120 |
Prophylaxis - child |
3,761 |
3,590 |
$88.20 |
| 91321 |
|
110 |
95 |
$87.20 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,605 |
3,044 |
$76.84 |
| 99201 |
|
563 |
326 |
$59.10 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,869 |
1,831 |
$51.45 |
| D0274 |
Bitewings - four radiographic images |
1,253 |
1,199 |
$40.43 |
| D0120 |
Periodic oral evaluation - established patient |
3,623 |
3,444 |
$33.08 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,222 |
3,888 |
$32.15 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
223 |
191 |
$31.40 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
292 |
251 |
$31.30 |
| 81002 |
|
3,000 |
2,384 |
$28.60 |
| 81025 |
|
1,239 |
940 |
$28.39 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,385 |
1,276 |
$25.73 |
| 80305 |
|
216 |
125 |
$17.96 |
| 90648 |
|
65 |
57 |
$16.05 |
| 82962 |
|
1,507 |
1,294 |
$1.68 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,598 |
1,309 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
153 |
139 |
$0.00 |
| 90647 |
|
1,412 |
1,180 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
577 |
565 |
$0.00 |
| 90677 |
|
514 |
460 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
144 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
937 |
891 |
$0.00 |
| 90656 |
|
466 |
427 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,233 |
2,167 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
662 |
626 |
$0.00 |
| 0500F |
|
62 |
57 |
$0.00 |
| 90723 |
|
1,294 |
1,123 |
$0.00 |
| D1330 |
|
2,067 |
1,806 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
726 |
657 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,816 |
1,770 |
$0.00 |
| 90619 |
|
193 |
189 |
$0.00 |
| 96127 |
|
959 |
947 |
$0.00 |
| D1310 |
|
293 |
272 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
102 |
97 |
$0.00 |
| 90381 |
|
41 |
38 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
32 |
32 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
68 |
53 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
13 |
13 |
$0.00 |
| 99383 |
|
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
683 |
659 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,587 |
2,502 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
680 |
626 |
$0.00 |
| 90682 |
|
129 |
87 |
$0.00 |
| 90681 |
|
784 |
675 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,872 |
2,262 |
$0.00 |
| 90713 |
|
18 |
14 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
382 |
350 |
$0.00 |
| D0270 |
|
142 |
142 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
33 |
13 |
$0.00 |
| 91322 |
|
14 |
14 |
$0.00 |
| 90380 |
|
15 |
15 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
26 |
25 |
$0.00 |