| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
67,707 |
50,837 |
$9.28M |
| D0999 |
Unspecified diagnostic procedure, by report |
9,751 |
8,683 |
$1.03M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
3,418 |
2,459 |
$261K |
| 90723 |
|
1,909 |
1,748 |
$75.38 |
| 90633 |
|
1,548 |
1,340 |
$36.77 |
| 90647 |
|
1,953 |
1,728 |
$30.00 |
| 90686 |
|
3,328 |
2,880 |
$26.40 |
| 90716 |
|
252 |
233 |
$6.40 |
| 90707 |
|
242 |
212 |
$6.40 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,555 |
3,237 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,648 |
3,563 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,831 |
3,766 |
$0.00 |
| 90619 |
|
316 |
306 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,749 |
4,317 |
$0.00 |
| D1330 |
|
1,801 |
1,684 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,878 |
3,796 |
$0.00 |
| 90680 |
|
1,389 |
1,258 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
824 |
550 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,599 |
1,256 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30,072 |
24,364 |
$0.00 |
| 90620 |
|
454 |
403 |
$0.00 |
| 90651 |
|
878 |
806 |
$0.00 |
| 90696 |
|
280 |
270 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
163 |
154 |
$0.00 |
| 96127 |
|
1,477 |
1,276 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,002 |
830 |
$0.00 |
| 87428 |
|
332 |
325 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
85 |
84 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
326 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
457 |
456 |
$0.00 |
| D0603 |
|
3,442 |
3,360 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
17 |
$0.00 |
| 90677 |
|
538 |
534 |
$0.00 |
| D0601 |
|
239 |
239 |
$0.00 |
| D1353 |
|
21 |
16 |
$0.00 |
| 0500F |
|
109 |
107 |
$0.00 |
| 90656 |
|
256 |
252 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
79 |
$0.00 |
| 99383 |
|
59 |
59 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
53 |
53 |
$0.00 |
| 99381 |
|
108 |
107 |
$0.00 |
| 93000 |
|
24 |
24 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
66 |
66 |
$0.00 |
| D1351 |
Sealant - per tooth |
340 |
218 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
56 |
52 |
$0.00 |
| 59430 |
|
15 |
14 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
30 |
28 |
$0.00 |
| 3079F |
|
15 |
14 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,827 |
4,350 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,253 |
2,044 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
692 |
592 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,230 |
3,174 |
$0.00 |
| 90670 |
|
2,096 |
1,843 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,412 |
3,001 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,315 |
1,090 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,953 |
1,892 |
$0.00 |
| 0502F |
|
4,328 |
2,724 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,650 |
3,266 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
273 |
251 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,362 |
2,360 |
$0.00 |
| 90710 |
|
305 |
291 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,557 |
2,329 |
$0.00 |
| 99401 |
|
356 |
110 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
353 |
347 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
42 |
37 |
$0.00 |
| 81025 |
|
34 |
30 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
157 |
141 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
4,379 |
4,265 |
$0.00 |
| 96160 |
|
834 |
716 |
$0.00 |
| 90734 |
|
613 |
580 |
$0.00 |
| D2140 |
|
47 |
41 |
$0.00 |
| 90700 |
|
205 |
202 |
$0.00 |
| 86703 |
|
82 |
81 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
24 |
24 |
$0.00 |
| 90681 |
|
237 |
236 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
189 |
172 |
$0.00 |
| 90715 |
|
758 |
730 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
16 |
$0.00 |
| D0270 |
|
42 |
42 |
$0.00 |
| N1351 |
|
78 |
78 |
$0.00 |
| 81002 |
|
16 |
14 |
$0.00 |
| 90649 |
|
13 |
13 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$0.00 |