| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
28,413 |
20,228 |
$2.07M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,319 |
4,529 |
$168K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,090 |
2,424 |
$122K |
| 90834 |
Psychotherapy, 45 minutes with patient |
4,886 |
1,560 |
$120K |
| D0330 |
Panoramic radiographic image |
4,764 |
3,636 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,762 |
1,997 |
$64K |
| D1110 |
Prophylaxis - adult |
4,625 |
3,450 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
5,116 |
3,845 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,764 |
1,104 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,031 |
2,363 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
2,981 |
2,202 |
$18K |
| D1206 |
Topical application of fluoride varnish |
3,017 |
2,111 |
$18K |
| D1120 |
Prophylaxis - child |
2,230 |
1,632 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
807 |
533 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,956 |
1,523 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,891 |
2,147 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
594 |
442 |
$6K |
| 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 |
296 |
262 |
$5K |
| 99442 |
|
384 |
201 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
139 |
79 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
16 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
153 |
56 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
177 |
101 |
$2K |
| 81002 |
|
1,561 |
655 |
$2K |
| D2332 |
|
62 |
41 |
$2K |
| 99406 |
|
266 |
149 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
20 |
13 |
$662.18 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
84 |
80 |
$601.41 |
| D1351 |
Sealant - per tooth |
76 |
14 |
$600.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
184 |
111 |
$584.59 |
| D1354 |
|
35 |
12 |
$433.30 |
| D0272 |
Bitewings - two radiographic images |
275 |
234 |
$425.43 |
| D2330 |
|
23 |
12 |
$376.39 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
51 |
19 |
$208.42 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
25 |
13 |
$160.27 |
| H1000 |
Prenatal care, at-risk assessment |
27 |
14 |
$146.53 |
| 36416 |
|
99 |
48 |
$111.99 |
| 85018 |
|
103 |
48 |
$91.83 |
| 3074F |
|
4,565 |
2,394 |
$0.07 |
| 3079F |
|
2,169 |
1,174 |
$0.06 |
| 3078F |
|
3,749 |
1,962 |
$0.06 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
1,946 |
1,022 |
$0.00 |
| 3080F |
|
1,107 |
561 |
$0.00 |
| 3075F |
|
787 |
420 |
$0.00 |
| 1036F |
|
2,249 |
1,188 |
$0.00 |
| 1000F |
|
1,596 |
840 |
$0.00 |
| 0001F |
|
5,389 |
2,904 |
$0.00 |
| G8418 |
Bmi is documented below normal parameters and a follow-up plan is documented |
25 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
268 |
252 |
$0.00 |
| D0603 |
|
111 |
66 |
$0.00 |
| 1111F |
|
29 |
13 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
25 |
13 |
$0.00 |
| D1999 |
|
922 |
724 |
$0.00 |
| 3077F |
|
1,218 |
625 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
2,781 |
1,451 |
$0.00 |
| 1159F |
|
121 |
115 |
$0.00 |
| 4004F |
|
37 |
22 |
$0.00 |
| 1160F |
|
121 |
115 |
$0.00 |
| 81025 |
|
16 |
12 |
$0.00 |