| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
79,394 |
45,937 |
$8.60M |
| D0999 |
Unspecified diagnostic procedure, by report |
8,923 |
7,729 |
$923K |
| 0001A |
|
292 |
259 |
$9K |
| 0002A |
|
212 |
148 |
$9K |
| 0012A |
|
86 |
86 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
52,837 |
29,764 |
$2K |
| 90658 |
|
1,364 |
777 |
$2K |
| 0011A |
|
102 |
102 |
$2K |
| 90649 |
|
301 |
144 |
$1K |
| 90670 |
|
1,896 |
1,392 |
$855.95 |
| 0071A |
|
20 |
19 |
$842.80 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,554 |
4,210 |
$417.12 |
| 90647 |
|
1,528 |
1,053 |
$277.09 |
| 36415 |
Collection of venous blood by venipuncture |
396 |
305 |
$229.60 |
| 90723 |
|
1,468 |
1,074 |
$160.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,582 |
3,503 |
$157.74 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,265 |
1,741 |
$153.68 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,770 |
2,234 |
$152.55 |
| 90633 |
|
633 |
346 |
$135.29 |
| 90688 |
|
260 |
240 |
$129.00 |
| 90680 |
|
1,133 |
843 |
$121.60 |
| 81025 |
|
481 |
229 |
$100.62 |
| 90657 |
|
587 |
287 |
$96.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,951 |
1,663 |
$93.89 |
| 90648 |
|
244 |
221 |
$89.60 |
| 90707 |
|
304 |
146 |
$85.08 |
| 90834 |
Psychotherapy, 45 minutes with patient |
262 |
140 |
$70.99 |
| 90715 |
|
257 |
151 |
$57.65 |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
105 |
$39.12 |
| 90700 |
|
235 |
123 |
$32.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
304 |
143 |
$31.50 |
| D0120 |
Periodic oral evaluation - established patient |
3,098 |
2,880 |
$29.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,102 |
1,972 |
$26.08 |
| D0274 |
Bitewings - four radiographic images |
1,047 |
992 |
$19.94 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
608 |
374 |
$16.07 |
| 90734 |
|
212 |
92 |
$12.80 |
| 90716 |
|
306 |
153 |
$12.63 |
| 99173 |
|
1,125 |
622 |
$7.45 |
| 82962 |
|
543 |
236 |
$6.72 |
| 90696 |
|
84 |
36 |
$6.40 |
| 90710 |
|
139 |
60 |
$6.40 |
| 85018 |
|
204 |
69 |
$4.64 |
| 81002 |
|
739 |
501 |
$2.60 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
569 |
402 |
$1.00 |
| D1351 |
Sealant - per tooth |
763 |
532 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
4,050 |
3,765 |
$0.00 |
| D0603 |
|
1,900 |
1,778 |
$0.00 |
| D0602 |
|
1,623 |
1,506 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
641 |
614 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,072 |
1,000 |
$0.00 |
| D0601 |
|
639 |
598 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
237 |
221 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
459 |
144 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
155 |
137 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
302 |
266 |
$0.00 |
| 99381 |
|
1,187 |
989 |
$0.00 |
| 92551 |
|
1,015 |
538 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
305 |
269 |
$0.00 |
| 59430 |
|
175 |
130 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
535 |
531 |
$0.00 |
| 94760 |
|
68 |
40 |
$0.00 |
| 99384 |
|
79 |
40 |
$0.00 |
| 90686 |
|
112 |
109 |
$0.00 |
| 3008F |
|
101 |
96 |
$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 |
114 |
89 |
$0.00 |
| 0503F |
|
180 |
96 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
25 |
$0.00 |
| 99383 |
|
113 |
88 |
$0.00 |
| 3074F |
|
65 |
60 |
$0.00 |
| 76801 |
|
210 |
136 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
17 |
12 |
$0.00 |
| 1036F |
|
49 |
35 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,082 |
790 |
$0.00 |
| D1120 |
Prophylaxis - child |
4,579 |
4,288 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,467 |
1,115 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
147 |
104 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
933 |
878 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
369 |
230 |
$0.00 |
| 0502F |
|
99 |
74 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
31 |
31 |
$0.00 |
| D0180 |
|
113 |
101 |
$0.00 |
| 90461 |
|
1,250 |
767 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
179 |
102 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
375 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
25 |
$0.00 |
| 3078F |
|
64 |
59 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
41 |
41 |
$0.00 |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$0.00 |
| D1354 |
|
39 |
20 |
$0.00 |