| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
209,549 |
148,411 |
$26.43M |
| D0999 |
Unspecified diagnostic procedure, by report |
50,952 |
40,530 |
$5.31M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
7,492 |
4,747 |
$575K |
| D0140 |
Limited oral evaluation - problem focused |
15,143 |
14,084 |
$64K |
| D1120 |
Prophylaxis - child |
10,305 |
9,656 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,808 |
6,760 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,147 |
5,798 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,677 |
2,162 |
$11K |
| D1110 |
Prophylaxis - adult |
2,708 |
2,591 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,966 |
1,599 |
$5K |
| D0330 |
Panoramic radiographic image |
1,078 |
1,007 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
2,171 |
2,070 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
7,629 |
7,204 |
$3K |
| 90651 |
|
3,431 |
3,048 |
$3K |
| 90716 |
|
3,054 |
2,568 |
$1K |
| 90734 |
|
3,158 |
2,805 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14,527 |
13,615 |
$834.40 |
| D4910 |
|
171 |
164 |
$772.80 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
47,468 |
37,195 |
$729.70 |
| D1354 |
|
870 |
654 |
$662.40 |
| D2331 |
|
265 |
182 |
$662.40 |
| 90707 |
|
3,010 |
2,531 |
$543.32 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
86,693 |
66,443 |
$457.53 |
| D5899 |
|
109 |
71 |
$331.20 |
| 90633 |
|
3,229 |
2,730 |
$279.73 |
| 90686 |
|
4,286 |
3,605 |
$266.42 |
| D0274 |
Bitewings - four radiographic images |
7,016 |
6,638 |
$220.80 |
| 90696 |
|
1,202 |
1,007 |
$206.90 |
| 90670 |
|
3,414 |
2,711 |
$179.20 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
5,775 |
4,980 |
$169.24 |
| 90715 |
|
1,600 |
1,442 |
$164.15 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
6,411 |
5,472 |
$153.68 |
| D1206 |
Topical application of fluoride varnish |
12,459 |
11,665 |
$130.40 |
| 90700 |
|
843 |
668 |
$84.88 |
| 90723 |
|
3,271 |
2,664 |
$75.38 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,583 |
2,947 |
$69.52 |
| 90832 |
Psychotherapy, 30 minutes with patient |
18,187 |
10,673 |
$58.96 |
| 0502F |
|
3,834 |
2,228 |
$44.10 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,787 |
1,494 |
$43.98 |
| 90648 |
|
3,923 |
3,202 |
$34.20 |
| 90685 |
|
369 |
227 |
$21.81 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,898 |
3,575 |
$11.40 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
11,557 |
10,060 |
$6.30 |
| 82962 |
|
3,203 |
2,740 |
$3.36 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,748 |
4,827 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
7,334 |
5,952 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,166 |
2,747 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
155 |
147 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
717 |
696 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
721 |
660 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
2,384 |
2,302 |
$0.00 |
| 80305 |
|
5,707 |
3,427 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
97 |
94 |
$0.00 |
| 99173 |
|
1,168 |
910 |
$0.00 |
| 82274 |
|
90 |
90 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
526 |
469 |
$0.00 |
| 90681 |
|
1,495 |
1,202 |
$0.00 |
| 86703 |
|
983 |
966 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
215 |
208 |
$0.00 |
| 81025 |
|
1,792 |
1,475 |
$0.00 |
| 87420 |
|
465 |
432 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,753 |
1,428 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
5,948 |
5,367 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
2,717 |
2,110 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
894 |
690 |
$0.00 |
| 90461 |
|
114 |
108 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
324 |
311 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
167 |
134 |
$0.00 |
| D2140 |
|
390 |
299 |
$0.00 |
| 99382 |
|
429 |
372 |
$0.00 |
| D0270 |
|
116 |
108 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,030 |
1,883 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
319 |
299 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
149 |
141 |
$0.00 |
| 81002 |
|
242 |
228 |
$0.00 |
| D2332 |
|
55 |
41 |
$0.00 |
| G8484 |
Influenza immunization was not administered, reason not given |
13 |
13 |
$0.00 |
| 83655 |
|
363 |
363 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
121 |
118 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
2,248 |
1,968 |
$0.00 |
| D2940 |
|
25 |
13 |
$0.00 |
| D4341 |
|
61 |
37 |
$0.00 |
| 99384 |
|
1,074 |
973 |
$0.00 |
| 87430 |
|
3,843 |
3,475 |
$0.00 |
| 99383 |
|
1,565 |
1,398 |
$0.00 |
| 86580 |
|
817 |
669 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,582 |
1,682 |
$0.00 |
| G9902 |
Patient screened for tobacco use and identified as a tobacco user |
833 |
639 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
602 |
557 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
215 |
208 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
3,695 |
3,445 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15,392 |
12,838 |
$0.00 |
| 81000 |
|
2,747 |
2,269 |
$0.00 |
| 90620 |
|
1,273 |
1,101 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
117 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,509 |
1,338 |
$0.00 |
| 99381 |
|
617 |
549 |
$0.00 |
| 96161 |
|
418 |
372 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
143 |
134 |
$0.00 |
| 96127 |
|
1,283 |
1,100 |
$0.00 |
| 90677 |
|
487 |
479 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
259 |
252 |
$0.00 |
| 90474 |
|
667 |
487 |
$0.00 |
| D2330 |
|
148 |
127 |
$0.00 |
| G9906 |
Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
793 |
609 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
7,919 |
7,663 |
$0.00 |
| 99386 |
|
19 |
18 |
$0.00 |
| 86803 |
|
359 |
355 |
$0.00 |
| G8950 |
Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented |
390 |
310 |
$0.00 |
| D1351 |
Sealant - per tooth |
916 |
397 |
$0.00 |
| 1036F |
|
54 |
52 |
$0.00 |
| 99385 |
|
46 |
45 |
$0.00 |
| 0500F |
|
84 |
72 |
$0.00 |
| 81001 |
|
115 |
104 |
$0.00 |
| 90656 |
|
408 |
381 |
$0.00 |