| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
35,213 |
25,665 |
$4.59M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
8,847 |
3,940 |
$1.20M |
| D9450 |
|
39,598 |
25,166 |
$1.15M |
| 90834 |
Psychotherapy, 45 minutes with patient |
15,835 |
7,561 |
$1.08M |
| 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 |
13,570 |
9,213 |
$422K |
| D1110 |
Prophylaxis - adult |
15,006 |
11,354 |
$410K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,042 |
809 |
$327K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,604 |
4,571 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
5,008 |
3,811 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
12,434 |
9,686 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,929 |
3,134 |
$163K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,426 |
2,989 |
$151K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
5,028 |
2,424 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
5,720 |
3,471 |
$135K |
| D0274 |
Bitewings - four radiographic images |
6,049 |
4,688 |
$131K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,424 |
3,553 |
$125K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
822 |
819 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,923 |
2,245 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,313 |
3,313 |
$88K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,886 |
1,882 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,166 |
1,545 |
$81K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,691 |
1,611 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
7,507 |
4,649 |
$73K |
| D1120 |
Prophylaxis - child |
1,296 |
1,291 |
$66K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
4,006 |
2,028 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,134 |
2,123 |
$55K |
| D2331 |
|
1,279 |
751 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
581 |
581 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,927 |
2,127 |
$32K |
| 92015 |
Determination of refractive state |
2,673 |
2,669 |
$32K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,862 |
3,750 |
$29K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,001 |
2,786 |
$27K |
| D4341 |
|
825 |
314 |
$26K |
| 90686 |
|
1,883 |
1,863 |
$22K |
| 0012A |
|
594 |
594 |
$19K |
| 0011A |
|
616 |
616 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
374 |
130 |
$17K |
| D2330 |
|
477 |
236 |
$16K |
| 90677 |
|
78 |
72 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
88 |
88 |
$15K |
| D2332 |
|
308 |
183 |
$14K |
| 92341 |
|
363 |
362 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
327 |
185 |
$12K |
| 0064A |
|
362 |
360 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,702 |
3,963 |
$11K |
| D2950 |
|
126 |
109 |
$11K |
| 90750 |
|
82 |
73 |
$9K |
| 91322 |
|
65 |
65 |
$9K |
| 90791 |
Psychiatric diagnostic evaluation |
66 |
66 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
53 |
53 |
$7K |
| D2335 |
|
119 |
66 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
908 |
877 |
$6K |
| 99443 |
|
341 |
285 |
$5K |
| 81025 |
|
723 |
676 |
$5K |
| D2394 |
|
76 |
69 |
$5K |
| 0134A |
|
98 |
98 |
$4K |
| D2160 |
|
102 |
58 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
304 |
290 |
$4K |
| 90715 |
|
137 |
134 |
$3K |
| 90480 |
|
69 |
69 |
$3K |
| 0124A |
|
61 |
61 |
$3K |
| 0001A |
|
60 |
60 |
$3K |
| 0004A |
|
52 |
51 |
$2K |
| 0071A |
|
42 |
42 |
$2K |
| 0002A |
|
37 |
37 |
$2K |
| 0054A |
|
39 |
36 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
47 |
47 |
$1K |
| 0072A |
|
28 |
28 |
$1K |
| 0031A |
|
25 |
25 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
135 |
128 |
$1K |
| 90651 |
|
26 |
26 |
$1K |
| D9110 |
|
42 |
25 |
$933.00 |
| 81002 |
|
280 |
271 |
$766.61 |
| D0270 |
|
98 |
70 |
$703.00 |
| 99442 |
|
146 |
119 |
$466.86 |
| D2140 |
|
17 |
12 |
$386.00 |
| 93000 |
|
14 |
14 |
$214.90 |
| 91306 |
|
323 |
321 |
$40.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
60 |
57 |
$24.56 |
| 81003 |
|
12 |
12 |
$23.76 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
179 |
159 |
$7.04 |
| 36415 |
Collection of venous blood by venipuncture |
40 |
37 |
$6.72 |
| 91303 |
|
25 |
25 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
447 |
443 |
$0.00 |
| 91307 |
|
88 |
86 |
$0.00 |
| 91301 |
|
830 |
822 |
$0.00 |
| 91305 |
|
126 |
120 |
$0.00 |
| 90674 |
|
28 |
28 |
$0.00 |
| 82962 |
|
13 |
12 |
$0.00 |
| 91300 |
|
235 |
218 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
521 |
500 |
$0.00 |
| 91313 |
|
98 |
98 |
$0.00 |
| 91312 |
|
61 |
61 |
$0.00 |
| 99348 |
|
41 |
25 |
$0.00 |
| 90662 |
|
80 |
79 |
$0.00 |