| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,969 |
4,728 |
$663K |
| H0037 |
Community psychiatric supportive treatment program, per diem |
1,112 |
955 |
$418K |
| H0040 |
Assertive community treatment program, per diem |
352 |
308 |
$408K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,586 |
5,730 |
$291K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,475 |
2,283 |
$123K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,120 |
1,031 |
$32K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
176 |
175 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
913 |
827 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
850 |
708 |
$7K |
| H0036 |
Community psychiatric supportive treatment, face-to-face, per 15 minutes |
5,413 |
1,133 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
81 |
81 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
67 |
67 |
$4K |
| 0012A |
|
76 |
76 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
253 |
190 |
$3K |
| 0011A |
|
73 |
71 |
$2K |
| 99201 |
|
90 |
84 |
$2K |
| 0003A |
|
47 |
37 |
$2K |
| 0001A |
|
46 |
46 |
$2K |
| 0031A |
|
48 |
48 |
$1K |
| 0002A |
|
30 |
29 |
$1K |
| 90461 |
|
360 |
340 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
28 |
27 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
17 |
17 |
$945.37 |
| 80305 |
|
137 |
129 |
$860.36 |
| 82962 |
|
429 |
397 |
$589.10 |
| 0013A |
|
14 |
14 |
$582.82 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
89 |
89 |
$456.57 |
| 81002 |
|
74 |
70 |
$171.68 |
| 81025 |
|
40 |
40 |
$148.40 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15 |
12 |
$117.75 |
| 86703 |
|
13 |
13 |
$104.65 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$96.00 |
| 90686 |
|
1,097 |
752 |
$76.79 |
| 90685 |
|
43 |
29 |
$3.01 |
| 90674 |
|
30 |
30 |
$2.10 |
| 90715 |
|
27 |
27 |
$1.89 |
| D1110 |
Prophylaxis - adult |
1,063 |
914 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
960 |
813 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
585 |
511 |
$0.00 |
| D1120 |
Prophylaxis - child |
833 |
678 |
$0.00 |
| H0046 |
Mental health services, not otherwise specified |
6,034 |
1,088 |
$0.00 |
| DS001 |
|
161 |
95 |
$0.00 |
| D2940 |
|
54 |
40 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
27 |
$0.00 |
| D0603 |
|
187 |
176 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
357 |
$0.00 |
| D0024 |
|
431 |
378 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,051 |
863 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
99 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,191 |
1,019 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
394 |
379 |
$0.00 |
| D0602 |
|
200 |
190 |
$0.00 |
| D1351 |
Sealant - per tooth |
479 |
140 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
92 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
117 |
$0.00 |
| D0601 |
|
21 |
21 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$0.00 |