| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
746,207 |
499,879 |
$99.47M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
18,045 |
13,229 |
$1.20M |
| D0999 |
Unspecified diagnostic procedure, by report |
5,011 |
4,578 |
$563K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
550 |
492 |
$261K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
275 |
202 |
$250K |
| 90651 |
|
12,299 |
11,013 |
$75K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
5,149 |
4,040 |
$64K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
177 |
155 |
$57K |
| 90715 |
|
13,885 |
12,103 |
$47K |
| 90686 |
|
36,045 |
31,884 |
$46K |
| 0001A |
|
626 |
433 |
$26K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
847 |
603 |
$25K |
| 90750 |
|
2,333 |
2,228 |
$24K |
| 90732 |
|
1,172 |
903 |
$22K |
| 0002A |
|
489 |
332 |
$21K |
| 90670 |
|
16,135 |
14,589 |
$20K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
24,361 |
19,963 |
$19K |
| 90716 |
|
6,102 |
5,396 |
$17K |
| 0124A |
|
418 |
338 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
319,651 |
251,183 |
$10K |
| 90707 |
|
6,057 |
5,364 |
$10K |
| 0011A |
|
326 |
322 |
$9K |
| 0012A |
|
240 |
240 |
$9K |
| 90734 |
|
9,995 |
8,877 |
$8K |
| 81025 |
|
50,319 |
43,085 |
$7K |
| 90633 |
|
11,217 |
10,086 |
$7K |
| 0071A |
|
157 |
137 |
$6K |
| 99460 |
|
152 |
124 |
$6K |
| 90739 |
|
1,519 |
1,272 |
$6K |
| 59430 |
|
495 |
450 |
$5K |
| 0004A |
|
89 |
89 |
$4K |
| 0072A |
|
83 |
76 |
$3K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
142 |
45 |
$3K |
| 90677 |
|
3,027 |
2,930 |
$3K |
| 90698 |
|
10,192 |
9,187 |
$3K |
| 90744 |
|
7,924 |
7,097 |
$3K |
| 90710 |
|
5,361 |
4,857 |
$3K |
| 90681 |
|
8,021 |
7,429 |
$3K |
| 90696 |
|
5,028 |
4,580 |
$3K |
| 0503F |
|
4,946 |
4,334 |
$3K |
| 0502F |
|
36,629 |
22,385 |
$3K |
| 99000 |
|
522 |
378 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
63,505 |
53,153 |
$2K |
| 59025 |
Fetal non-stress test |
1,868 |
944 |
$2K |
| 3008F |
|
230,051 |
197,717 |
$2K |
| 90700 |
|
4,613 |
4,192 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
21,951 |
19,003 |
$2K |
| 96127 |
|
196,611 |
145,067 |
$2K |
| 90648 |
|
4,633 |
4,217 |
$2K |
| 11981 |
|
1,014 |
868 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
14,261 |
10,877 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
62,923 |
42,256 |
$1K |
| 58300 |
|
925 |
826 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
39,540 |
36,442 |
$1K |
| 90697 |
|
3,007 |
2,906 |
$1K |
| 0064A |
|
31 |
31 |
$1K |
| S5190 |
Wellness assessment, performed by non-physician |
12,377 |
10,102 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
45,339 |
40,325 |
$1K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
123,772 |
104,841 |
$1K |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
95,902 |
83,446 |
$1K |
| 90649 |
|
390 |
290 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
85,448 |
75,726 |
$1K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
592 |
456 |
$1K |
| 11976 |
|
648 |
558 |
$976.67 |
| 82962 |
|
36,402 |
28,887 |
$922.40 |
| 81002 |
|
47,477 |
37,940 |
$910.32 |
| 0500F |
|
4,601 |
4,201 |
$883.88 |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
37 |
25 |
$847.00 |
| 99383 |
|
1,731 |
1,612 |
$781.20 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
27,160 |
23,329 |
$669.30 |
| H0050 |
Alcohol and/or drug services, brief intervention, per 15 minutes |
67,027 |
52,262 |
$668.00 |
| 90756 |
|
4,416 |
2,990 |
$644.02 |
| 86580 |
|
2,219 |
1,692 |
$613.06 |
| 80305 |
|
20,395 |
13,642 |
$608.48 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
34,062 |
30,307 |
$554.00 |
| 90713 |
|
662 |
539 |
$549.49 |
| 0013A |
|
13 |
13 |
$547.82 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
24,787 |
23,237 |
$535.04 |
| 90620 |
|
449 |
416 |
$531.68 |
| 20610 |
|
1,293 |
999 |
$495.03 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
38,577 |
34,527 |
$473.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
23,446 |
21,960 |
$448.84 |
| 90746 |
|
364 |
240 |
$448.68 |
| 90480 |
|
19 |
16 |
$401.20 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
9,730 |
8,699 |
$379.40 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,695 |
1,358 |
$369.96 |
| 85610 |
|
717 |
418 |
$284.12 |
| 36416 |
|
19,884 |
12,170 |
$265.50 |
| 2015F |
|
19,507 |
16,337 |
$249.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
17,449 |
16,213 |
$231.00 |
| 4010F |
|
12,455 |
9,299 |
$229.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
31,698 |
25,099 |
$228.00 |
| 99384 |
|
1,618 |
1,455 |
$222.92 |
| 3074F |
|
96,448 |
83,877 |
$217.00 |
| 90723 |
|
645 |
579 |
$201.60 |
| D0120 |
Periodic oral evaluation - established patient |
2,151 |
2,105 |
$196.00 |
| 3078F |
|
86,180 |
75,396 |
$196.00 |
| 3077F |
|
22,529 |
19,449 |
$195.00 |
| 99173 |
|
5,703 |
5,144 |
$193.95 |
| 99385 |
|
1,629 |
1,503 |
$174.60 |
| 3044F |
|
12,231 |
10,367 |
$173.00 |
| 3079F |
|
38,015 |
33,874 |
$173.00 |
| 94200 |
|
9,389 |
6,613 |
$164.60 |
| 3061F |
|
10,706 |
8,233 |
$157.00 |
| 3080F |
|
17,066 |
14,730 |
$151.00 |
| D1120 |
Prophylaxis - child |
2,416 |
2,356 |
$125.05 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
689 |
$124.13 |
| 90662 |
|
190 |
189 |
$113.54 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
10,398 |
9,622 |
$111.50 |
| 3075F |
|
22,210 |
19,820 |
$105.00 |
| 99386 |
|
633 |
577 |
$104.96 |
| 99381 |
|
1,891 |
1,808 |
$101.84 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
3,739 |
3,466 |
$101.60 |
| 3046F |
|
6,130 |
5,081 |
$99.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
11,216 |
10,617 |
$94.00 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,300 |
1,182 |
$86.90 |
| 85018 |
|
4,128 |
3,657 |
$85.82 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,848 |
1,609 |
$79.72 |
| D1206 |
Topical application of fluoride varnish |
2,165 |
2,112 |
$79.30 |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
57 |
$78.24 |
| 58301 |
|
208 |
181 |
$77.80 |
| 76801 |
|
772 |
717 |
$74.90 |
| 90473 |
|
4,763 |
4,481 |
$72.00 |
| 3060F |
|
3,003 |
2,054 |
$69.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
7,289 |
6,689 |
$60.00 |
| D0274 |
Bitewings - four radiographic images |
720 |
694 |
$59.82 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
421 |
334 |
$56.82 |
| 98926 |
|
2,299 |
1,674 |
$55.00 |
| 3052F |
|
1,587 |
1,528 |
$51.00 |
| 3051F |
|
2,787 |
2,689 |
$49.00 |
| G8418 |
Bmi is documented below normal parameters and a follow-up plan is documented |
5,021 |
4,203 |
$47.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,600 |
1,485 |
$45.26 |
| 93000 |
|
424 |
393 |
$44.30 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,077 |
3,835 |
$44.00 |
| 36415 |
Collection of venous blood by venipuncture |
7,931 |
6,877 |
$42.20 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
127 |
$36.40 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
1,503 |
1,243 |
$34.20 |
| D0272 |
Bitewings - two radiographic images |
596 |
587 |
$33.27 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
999 |
899 |
$33.00 |
| 3066F |
|
2,373 |
1,587 |
$20.00 |
| G0008 |
Administration of influenza virus vaccine |
302 |
244 |
$19.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
948 |
875 |
$17.92 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,357 |
1,348 |
$12.00 |
| A9150 |
Non-prescription drugs |
2,189 |
2,004 |
$11.00 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
1,119 |
1,023 |
$9.00 |
| 90632 |
|
186 |
146 |
$6.40 |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
23 |
15 |
$6.00 |
| 98925 |
|
497 |
400 |
$4.00 |
| 99382 |
|
681 |
613 |
$3.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
6,395 |
4,869 |
$1.00 |
| 99408 |
|
1,231 |
1,031 |
$1.00 |
| 91312 |
|
51 |
50 |
$0.04 |
| 91300 |
|
86 |
82 |
$0.01 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
220 |
212 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
308 |
252 |
$0.00 |
| G0396 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
710 |
629 |
$0.00 |
| D1351 |
Sealant - per tooth |
937 |
443 |
$0.00 |
| 94760 |
|
395 |
310 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
239 |
192 |
$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 |
194 |
186 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
17 |
12 |
$0.00 |
| 99243 |
|
219 |
151 |
$0.00 |
| 99406 |
|
168 |
142 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
367 |
306 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$0.00 |
| 57454 |
|
90 |
81 |
$0.00 |
| 58100 |
|
39 |
38 |
$0.00 |
| 90381 |
|
19 |
15 |
$0.00 |
| 90657 |
|
54 |
41 |
$0.00 |
| 82270 |
|
12 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
707 |
689 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
511 |
407 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,342 |
1,225 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
4,825 |
2,052 |
$0.00 |
| 3045F |
|
3,022 |
1,921 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
7,972 |
7,758 |
$0.00 |
| 17110 |
|
158 |
126 |
$0.00 |
| 87220 |
|
430 |
374 |
$0.00 |
| 96160 |
|
119 |
113 |
$0.00 |
| 90682 |
|
58 |
52 |
$0.00 |
| 99397 |
|
64 |
50 |
$0.00 |
| 99201 |
|
51 |
37 |
$0.00 |
| 90685 |
|
74 |
68 |
$0.00 |
| 90658 |
|
42 |
37 |
$0.00 |
| 96381 |
|
14 |
14 |
$0.00 |
| 2024F |
|
30 |
20 |
$0.00 |
| 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 |
13 |
12 |
$0.00 |
| 69210 |
|
12 |
12 |
$0.00 |