| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
120,918 |
92,513 |
$7.88M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
71,562 |
37,147 |
$1.67M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,932 |
10,378 |
$594K |
| D0330 |
Panoramic radiographic image |
14,066 |
10,103 |
$301K |
| D1110 |
Prophylaxis - adult |
13,047 |
9,385 |
$253K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,100 |
4,558 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,921 |
11,319 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
20,455 |
14,184 |
$203K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
20,516 |
6,217 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,469 |
3,565 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,376 |
16,857 |
$164K |
| D1120 |
Prophylaxis - child |
14,188 |
9,819 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
12,205 |
8,313 |
$142K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
8,701 |
5,567 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,723 |
2,367 |
$134K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,172 |
2,432 |
$125K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,409 |
2,119 |
$108K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,336 |
1,913 |
$108K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,531 |
1,578 |
$105K |
| D0274 |
Bitewings - four radiographic images |
11,787 |
8,745 |
$95K |
| D1351 |
Sealant - per tooth |
8,563 |
2,012 |
$95K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,374 |
1,166 |
$95K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,957 |
3,906 |
$90K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,620 |
3,410 |
$86K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,254 |
1,847 |
$84K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,745 |
1,242 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
25,372 |
17,897 |
$61K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,465 |
577 |
$60K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
3,951 |
2,276 |
$58K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,926 |
2,872 |
$57K |
| 92341 |
|
1,849 |
1,801 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
2,998 |
1,293 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,423 |
10,986 |
$39K |
| 81025 |
|
10,511 |
6,510 |
$37K |
| 92015 |
Determination of refractive state |
8,660 |
5,448 |
$36K |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
2,291 |
1,327 |
$33K |
| Q3014 |
Telehealth originating site facility fee |
2,284 |
1,277 |
$30K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
887 |
511 |
$26K |
| 92551 |
|
7,771 |
4,671 |
$20K |
| 90791 |
Psychiatric diagnostic evaluation |
392 |
214 |
$20K |
| 81002 |
|
16,483 |
7,909 |
$18K |
| D0272 |
Bitewings - two radiographic images |
4,967 |
3,456 |
$18K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,644 |
1,164 |
$16K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
507 |
293 |
$16K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
480 |
274 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,256 |
1,196 |
$13K |
| 80305 |
|
1,967 |
845 |
$10K |
| V2020 |
Frames, purchases |
994 |
950 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
906 |
554 |
$9K |
| H1000 |
Prenatal care, at-risk assessment |
116 |
97 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,922 |
1,672 |
$8K |
| 0001A |
|
209 |
195 |
$7K |
| 99173 |
|
5,369 |
3,196 |
$7K |
| 0002A |
|
196 |
179 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
93 |
$6K |
| 90756 |
|
433 |
263 |
$6K |
| 0011A |
|
123 |
110 |
$5K |
| 0012A |
|
119 |
111 |
$5K |
| 90715 |
|
602 |
502 |
$4K |
| J3490 |
Unclassified drugs |
183 |
93 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
47 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
712 |
502 |
$3K |
| 90688 |
|
1,027 |
806 |
$3K |
| 0064A |
|
62 |
60 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
735 |
699 |
$3K |
| 90670 |
|
1,591 |
1,401 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
125 |
67 |
$3K |
| 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 |
394 |
317 |
$2K |
| 99383 |
|
95 |
63 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
35 |
25 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
99 |
99 |
$2K |
| 99381 |
|
64 |
40 |
$2K |
| 99382 |
|
50 |
39 |
$2K |
| 90686 |
|
3,130 |
2,812 |
$2K |
| D2140 |
|
37 |
17 |
$1K |
| 97802 |
|
65 |
55 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
14 |
12 |
$1K |
| 90651 |
|
1,499 |
1,307 |
$1K |
| 99188 |
|
172 |
106 |
$1K |
| 90710 |
|
102 |
97 |
$1K |
| 90658 |
|
53 |
52 |
$826.78 |
| 99384 |
|
14 |
14 |
$784.91 |
| 90633 |
|
1,270 |
1,133 |
$614.87 |
| 90620 |
|
722 |
619 |
$594.93 |
| 92133 |
|
60 |
58 |
$480.40 |
| 90707 |
|
561 |
491 |
$469.64 |
| 90734 |
|
1,136 |
1,002 |
$465.34 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
26 |
$432.00 |
| 11721 |
|
18 |
14 |
$353.34 |
| 90680 |
|
433 |
329 |
$311.50 |
| 90698 |
|
654 |
550 |
$268.50 |
| 90716 |
|
615 |
531 |
$245.60 |
| 90744 |
|
524 |
442 |
$240.00 |
| 90700 |
|
316 |
284 |
$184.90 |
| 90713 |
|
130 |
124 |
$164.64 |
| 90685 |
|
209 |
183 |
$163.00 |
| 90461 |
|
884 |
418 |
$141.75 |
| 90697 |
|
45 |
41 |
$132.77 |
| 93000 |
|
21 |
16 |
$81.90 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
25 |
13 |
$80.08 |
| 90696 |
|
131 |
109 |
$30.00 |
| 90648 |
|
247 |
228 |
$20.00 |
| 3044F |
|
324 |
284 |
$20.00 |
| 90723 |
|
22 |
14 |
$10.00 |
| 91309 |
|
30 |
28 |
$0.02 |
| 91311 |
|
15 |
15 |
$0.01 |
| 91301 |
|
307 |
289 |
$0.01 |
| 3078F |
|
39,813 |
34,706 |
$0.00 |
| 4004F |
|
25,539 |
22,536 |
$0.00 |
| 1160F |
|
8,754 |
7,465 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
310 |
282 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
6,554 |
5,609 |
$0.00 |
| 1159F |
|
8,749 |
7,462 |
$0.00 |
| 3050F |
|
129 |
111 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
16 |
15 |
$0.00 |
| 3077F |
|
136 |
121 |
$0.00 |
| 90687 |
|
41 |
30 |
$0.00 |
| 91300 |
|
373 |
302 |
$0.00 |
| 2022F |
|
32 |
31 |
$0.00 |
| 90671 |
|
61 |
59 |
$0.00 |
| 3074F |
|
45,765 |
39,258 |
$0.00 |
| 1036F |
|
32,947 |
26,608 |
$0.00 |
| 3075F |
|
1,661 |
1,543 |
$0.00 |
| 3079F |
|
8,752 |
7,753 |
$0.00 |
| 3008F |
|
6,406 |
5,480 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
3,610 |
3,166 |
$0.00 |
| 3048F |
|
1,021 |
791 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
13 |
12 |
$0.00 |
| 90656 |
|
190 |
187 |
$0.00 |
| 3049F |
|
381 |
314 |
$0.00 |
| 91306 |
|
58 |
58 |
$0.00 |
| D0240 |
|
13 |
13 |
$0.00 |
| 1125F |
|
38 |
33 |
$0.00 |
| 2001F |
|
20 |
18 |
$0.00 |
| 3080F |
|
14 |
14 |
$0.00 |
| 4010F |
|
31 |
22 |
$0.00 |