| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
49,872 |
38,227 |
$3.76M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,311 |
8,917 |
$245K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,258 |
3,758 |
$198K |
| 90837 |
Psychotherapy, 53 minutes with patient |
4,867 |
2,210 |
$197K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,856 |
1,700 |
$90K |
| D0330 |
Panoramic radiographic image |
7,426 |
5,131 |
$79K |
| D1110 |
Prophylaxis - adult |
6,198 |
4,603 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,673 |
655 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,778 |
885 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,624 |
5,299 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
7,696 |
5,593 |
$35K |
| D0274 |
Bitewings - four radiographic images |
6,117 |
4,525 |
$34K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,393 |
607 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,014 |
353 |
$27K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,983 |
1,116 |
$26K |
| 90791 |
Psychiatric diagnostic evaluation |
549 |
300 |
$23K |
| D9944 |
|
120 |
104 |
$18K |
| D1120 |
Prophylaxis - child |
4,006 |
2,964 |
$18K |
| D1206 |
Topical application of fluoride varnish |
4,800 |
3,474 |
$18K |
| 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 |
1,438 |
1,023 |
$15K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
12 |
12 |
$15K |
| D5110 |
|
27 |
25 |
$8K |
| D5120 |
|
13 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
141 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
1,124 |
925 |
$3K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
97 |
63 |
$3K |
| 80305 |
|
519 |
287 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,525 |
1,165 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
13 |
$2K |
| 90674 |
|
168 |
96 |
$2K |
| D0272 |
Bitewings - two radiographic images |
759 |
591 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
224 |
123 |
$1K |
| D2140 |
|
25 |
13 |
$966.00 |
| D2950 |
|
19 |
14 |
$562.59 |
| D0230 |
Intraoral - periapical each additional radiographic image |
326 |
139 |
$414.75 |
| 90686 |
|
112 |
72 |
$291.30 |
| 90756 |
|
39 |
20 |
$189.02 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$174.84 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
34 |
29 |
$55.23 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
23 |
12 |
$28.50 |
| 99173 |
|
47 |
41 |
$21.88 |
| 3079F |
|
1,674 |
1,169 |
$0.10 |
| 3074F |
|
3,062 |
2,076 |
$0.09 |
| 3075F |
|
736 |
521 |
$0.04 |
| 3078F |
|
2,590 |
1,764 |
$0.03 |
| 3077F |
|
792 |
569 |
$0.02 |
| 4004F |
|
1,092 |
656 |
$0.00 |
| 3725F |
|
999 |
617 |
$0.00 |
| T2003 |
Non-emergency transportation; encounter/trip |
502 |
288 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
17 |
15 |
$0.00 |
| 1036F |
|
1,802 |
1,104 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
191 |
$0.00 |
| 3008F |
|
4,407 |
2,691 |
$0.00 |
| 3080F |
|
311 |
231 |
$0.00 |
| 87430 |
|
17 |
13 |
$0.00 |
| D2335 |
|
18 |
15 |
$0.00 |