| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
84,971 |
74,879 |
$18.87M |
| G9012 |
Other specified case management service not elsewhere classified |
330 |
323 |
$88K |
| 0012A |
|
983 |
974 |
$38K |
| 0011A |
|
1,020 |
1,015 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,266 |
10,235 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,823 |
12,827 |
$8K |
| 0064A |
|
144 |
144 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
374 |
367 |
$3K |
| 90688 |
|
2,303 |
2,020 |
$2K |
| 92552 |
|
1,798 |
1,727 |
$2K |
| 99173 |
|
2,002 |
1,920 |
$1K |
| D5899 |
|
468 |
293 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,940 |
1,846 |
$792.78 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
346 |
341 |
$746.41 |
| 0134A |
|
39 |
39 |
$440.00 |
| D1110 |
Prophylaxis - adult |
2,684 |
2,554 |
$378.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,163 |
1,113 |
$315.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,473 |
4,306 |
$224.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
321 |
$130.00 |
| D1206 |
Topical application of fluoride varnish |
5,266 |
5,194 |
$122.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,104 |
884 |
$120.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,725 |
2,644 |
$112.00 |
| D1120 |
Prophylaxis - child |
3,282 |
3,241 |
$98.00 |
| D0274 |
Bitewings - four radiographic images |
1,623 |
1,544 |
$87.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
483 |
443 |
$52.00 |
| D0272 |
Bitewings - two radiographic images |
1,652 |
1,635 |
$21.00 |
| 96127 |
|
166 |
156 |
$11.76 |
| 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 |
128 |
98 |
$11.74 |
| 3074F |
|
523 |
499 |
$10.00 |
| 3079F |
|
165 |
159 |
$10.00 |
| D0602 |
|
272 |
269 |
$0.00 |
| 90651 |
|
410 |
381 |
$0.00 |
| D0603 |
|
2,526 |
2,510 |
$0.00 |
| 90620 |
|
61 |
54 |
$0.00 |
| D2335 |
|
96 |
68 |
$0.00 |
| 1036F |
|
1,327 |
1,245 |
$0.00 |
| D1330 |
|
6,096 |
5,931 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
156 |
$0.00 |
| 90698 |
|
379 |
369 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,902 |
588 |
$0.00 |
| 1034F |
|
465 |
433 |
$0.00 |
| 3008F |
|
826 |
772 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
232 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
675 |
663 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
758 |
724 |
$0.00 |
| 3044F |
|
293 |
268 |
$0.00 |
| 91301 |
|
1,307 |
1,252 |
$0.00 |
| D2330 |
|
124 |
88 |
$0.00 |
| 36416 |
|
30 |
27 |
$0.00 |
| 90696 |
|
29 |
29 |
$0.00 |
| 90677 |
|
100 |
100 |
$0.00 |
| 90619 |
|
58 |
56 |
$0.00 |
| D2331 |
|
176 |
134 |
$0.00 |
| 91306 |
|
55 |
55 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 90744 |
|
28 |
28 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
67 |
46 |
$0.00 |
| 90739 |
|
42 |
40 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
16 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,238 |
1,169 |
$0.00 |
| 96160 |
|
158 |
156 |
$0.00 |
| D1354 |
|
57 |
26 |
$0.00 |
| 3016F |
|
3,449 |
3,271 |
$0.00 |
| 3725F |
|
4,270 |
3,981 |
$0.00 |
| 1160F |
|
1,686 |
1,597 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
159 |
158 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
138 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
970 |
747 |
$0.00 |
| 80305 |
|
187 |
147 |
$0.00 |
| 90715 |
|
503 |
466 |
$0.00 |
| 90734 |
|
183 |
169 |
$0.00 |
| 90710 |
|
43 |
43 |
$0.00 |
| 90633 |
|
231 |
204 |
$0.00 |
| 3078F |
|
415 |
400 |
$0.00 |
| 90670 |
|
338 |
324 |
$0.00 |
| 90658 |
|
227 |
226 |
$0.00 |
| D2140 |
|
52 |
42 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
157 |
137 |
$0.00 |
| 91313 |
|
30 |
30 |
$0.00 |
| 90750 |
|
12 |
12 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
16 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
24 |
24 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
56 |
40 |
$0.00 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$0.00 |