| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
49,056 |
35,325 |
$3.55M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,316 |
12,210 |
$428K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
9,337 |
5,666 |
$171K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,931 |
3,442 |
$165K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,799 |
2,243 |
$111K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,323 |
1,930 |
$79K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,033 |
4,161 |
$74K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,448 |
1,411 |
$71K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,385 |
834 |
$47K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,765 |
899 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,016 |
1,109 |
$28K |
| 90651 |
|
365 |
234 |
$24K |
| 90837 |
Psychotherapy, 53 minutes with patient |
849 |
326 |
$24K |
| 90677 |
|
205 |
187 |
$21K |
| D1110 |
Prophylaxis - adult |
2,704 |
1,925 |
$17K |
| 90686 |
|
2,657 |
1,586 |
$16K |
| 90834 |
Psychotherapy, 45 minutes with patient |
577 |
224 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
3,141 |
2,130 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
3,538 |
2,660 |
$11K |
| 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 |
773 |
724 |
$11K |
| 96160 |
|
8,368 |
4,826 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,187 |
2,838 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,243 |
1,106 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,634 |
1,155 |
$9K |
| D0274 |
Bitewings - four radiographic images |
3,156 |
2,228 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,826 |
1,062 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,326 |
790 |
$7K |
| 90832 |
Psychotherapy, 30 minutes with patient |
445 |
221 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
5,697 |
3,962 |
$6K |
| D1120 |
Prophylaxis - child |
1,604 |
1,269 |
$5K |
| 90734 |
|
251 |
160 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,199 |
$5K |
| D0330 |
Panoramic radiographic image |
2,395 |
1,549 |
$5K |
| 90670 |
|
2,308 |
1,453 |
$4K |
| 90698 |
|
2,161 |
1,372 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
755 |
357 |
$4K |
| 90633 |
|
860 |
556 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,872 |
1,606 |
$3K |
| 99381 |
|
117 |
69 |
$3K |
| D4910 |
|
498 |
407 |
$2K |
| 90688 |
|
398 |
250 |
$2K |
| D1354 |
|
706 |
198 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
69 |
33 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
36 |
25 |
$1K |
| 90744 |
|
1,004 |
632 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
25 |
$1K |
| 90715 |
|
179 |
105 |
$1K |
| 90658 |
|
184 |
88 |
$728.86 |
| 90716 |
|
244 |
157 |
$708.95 |
| 99188 |
|
68 |
55 |
$636.59 |
| 0012A |
|
23 |
23 |
$596.19 |
| 90681 |
|
402 |
265 |
$439.50 |
| 90710 |
|
129 |
70 |
$365.00 |
| 90707 |
|
212 |
140 |
$315.58 |
| 90696 |
|
68 |
37 |
$291.00 |
| 0011A |
|
13 |
13 |
$203.28 |
| D0270 |
|
52 |
38 |
$160.50 |
| 90700 |
|
18 |
13 |
$51.00 |
| 90656 |
|
78 |
78 |
$49.60 |
| 90685 |
|
79 |
48 |
$20.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
228 |
215 |
$0.83 |
| 3079F |
|
2,327 |
1,828 |
$0.77 |
| 3077F |
|
997 |
802 |
$0.53 |
| 3074F |
|
8,024 |
6,733 |
$0.53 |
| 3075F |
|
1,020 |
872 |
$0.47 |
| 3078F |
|
8,484 |
6,074 |
$0.36 |
| 3080F |
|
594 |
441 |
$0.32 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
26 |
$0.00 |
| 3008F |
|
12,134 |
7,123 |
$0.00 |
| D1330 |
|
116 |
99 |
$0.00 |
| D0603 |
|
300 |
263 |
$0.00 |
| 90619 |
|
29 |
15 |
$0.00 |
| D2160 |
|
21 |
12 |
$0.00 |
| 91301 |
|
35 |
35 |
$0.00 |