| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
63,261 |
57,377 |
$6.84M |
| 0012A |
|
655 |
654 |
$24K |
| 0011A |
|
592 |
590 |
$17K |
| 0001A |
|
245 |
245 |
$9K |
| 0002A |
|
227 |
227 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,011 |
12,556 |
$7K |
| 0064A |
|
124 |
124 |
$5K |
| 99499 |
|
142 |
133 |
$3K |
| 91320 |
|
62 |
58 |
$2K |
| 0072A |
|
42 |
42 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,907 |
2,874 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,443 |
1,434 |
$1K |
| 0071A |
|
35 |
35 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
7,072 |
6,942 |
$834.57 |
| 90686 |
|
957 |
929 |
$540.00 |
| 3074F |
|
270 |
269 |
$540.00 |
| 92551 |
|
4,937 |
4,890 |
$500.26 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,740 |
1,728 |
$499.19 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,768 |
3,704 |
$401.72 |
| 3078F |
|
173 |
171 |
$360.00 |
| 59425 |
|
305 |
238 |
$239.38 |
| 90461 |
|
3,771 |
3,736 |
$199.63 |
| 90734 |
|
454 |
451 |
$80.00 |
| 92553 |
|
378 |
377 |
$58.37 |
| 90656 |
|
126 |
126 |
$48.00 |
| 90633 |
|
1,001 |
995 |
$33.00 |
| 90670 |
|
962 |
947 |
$20.00 |
| 90685 |
|
55 |
53 |
$20.00 |
| 3079F |
|
155 |
154 |
$20.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
906 |
892 |
$7.00 |
| 82948 |
|
1,370 |
1,350 |
$0.00 |
| 99173 |
|
4,284 |
4,241 |
$0.00 |
| 88164 |
|
315 |
313 |
$0.00 |
| 83655 |
|
613 |
609 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,246 |
1,220 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,162 |
2,157 |
$0.00 |
| D1120 |
Prophylaxis - child |
496 |
493 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,021 |
1,010 |
$0.00 |
| 90715 |
|
297 |
296 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,281 |
1,277 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
385 |
376 |
$0.00 |
| 3077F |
|
63 |
62 |
$0.00 |
| 90710 |
|
263 |
263 |
$0.00 |
| 90707 |
|
116 |
113 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,492 |
1,449 |
$0.00 |
| 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 |
737 |
723 |
$0.00 |
| D1999 |
|
445 |
410 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
342 |
$0.00 |
| 90621 |
|
97 |
95 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
328 |
325 |
$0.00 |
| D0330 |
Panoramic radiographic image |
497 |
495 |
$0.00 |
| 59426 |
|
413 |
220 |
$0.00 |
| 81002 |
|
168 |
122 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
116 |
116 |
$0.00 |
| 99490 |
Ccm add 20min |
49 |
43 |
$0.00 |
| D9110 |
|
106 |
106 |
$0.00 |
| 87210 |
|
114 |
112 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
18 |
$0.00 |
| 90648 |
|
14 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
991 |
986 |
$0.00 |
| 90688 |
|
724 |
718 |
$0.00 |
| 90680 |
|
1,212 |
1,201 |
$0.00 |
| D1330 |
|
487 |
487 |
$0.00 |
| 85018 |
|
859 |
853 |
$0.00 |
| 90677 |
|
464 |
460 |
$0.00 |
| 90651 |
|
624 |
619 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,181 |
708 |
$0.00 |
| 90744 |
|
963 |
952 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
593 |
507 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
733 |
717 |
$0.00 |
| 90698 |
|
1,741 |
1,725 |
$0.00 |
| 59430 |
|
12 |
12 |
$0.00 |
| 90696 |
|
220 |
220 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
631 |
629 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,026 |
1,022 |
$0.00 |
| 90619 |
|
12 |
12 |
$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 |
263 |
225 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
107 |
$0.00 |
| 99381 |
|
54 |
54 |
$0.00 |
| 3080F |
|
12 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
635 |
434 |
$0.00 |
| D00CP |
|
14 |
14 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
136 |
125 |
$0.00 |
| 90716 |
|
122 |
119 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$0.00 |
| 90474 |
|
58 |
58 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
17 |
$0.00 |
| D2330 |
|
14 |
12 |
$0.00 |
| D5899 |
|
78 |
51 |
$0.00 |
| 90657 |
|
15 |
15 |
$0.00 |