| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
39,714 |
31,109 |
$3.03M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
23,366 |
12,330 |
$494K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,622 |
7,419 |
$451K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,220 |
1,119 |
$90K |
| D0330 |
Panoramic radiographic image |
3,952 |
2,656 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,834 |
1,462 |
$83K |
| D1110 |
Prophylaxis - adult |
3,357 |
2,306 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,427 |
1,238 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,503 |
3,006 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,121 |
3,584 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
3,653 |
2,487 |
$40K |
| D1120 |
Prophylaxis - child |
2,862 |
1,941 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
2,818 |
1,851 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,054 |
540 |
$29K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,669 |
742 |
$22K |
| Q3014 |
Telehealth originating site facility fee |
1,549 |
856 |
$21K |
| 80305 |
|
3,122 |
1,333 |
$16K |
| 90832 |
Psychotherapy, 30 minutes with patient |
794 |
324 |
$16K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,310 |
748 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,870 |
1,415 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
3,288 |
2,182 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
663 |
421 |
$7K |
| 90756 |
|
391 |
239 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
481 |
359 |
$5K |
| 90715 |
|
277 |
175 |
$4K |
| 81025 |
|
1,084 |
579 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
108 |
$4K |
| 90791 |
Psychiatric diagnostic evaluation |
67 |
37 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
170 |
95 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
130 |
70 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
55 |
26 |
$2K |
| 99215 |
Prolong outpt/office vis |
42 |
29 |
$2K |
| 90688 |
|
340 |
227 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
569 |
350 |
$2K |
| D0272 |
Bitewings - two radiographic images |
363 |
264 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
53 |
40 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
217 |
120 |
$1K |
| 11721 |
|
53 |
49 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
736 |
468 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
17 |
$940.26 |
| 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 |
275 |
235 |
$902.63 |
| 81002 |
|
534 |
292 |
$625.28 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
47 |
29 |
$617.24 |
| 92015 |
Determination of refractive state |
332 |
228 |
$583.24 |
| 90686 |
|
204 |
164 |
$549.29 |
| 92551 |
|
147 |
88 |
$404.80 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
26 |
$395.16 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
19 |
12 |
$260.96 |
| 93000 |
|
19 |
12 |
$180.89 |
| 99173 |
|
63 |
49 |
$64.80 |
| 3074F |
|
14,296 |
12,565 |
$0.00 |
| 3075F |
|
2,140 |
1,941 |
$0.00 |
| 3079F |
|
3,764 |
3,421 |
$0.00 |
| 1036F |
|
10,699 |
9,043 |
$0.00 |
| 2001F |
|
285 |
250 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,187 |
1,039 |
$0.00 |
| 3008F |
|
2,897 |
2,560 |
$0.00 |
| 3049F |
|
125 |
107 |
$0.00 |
| 3048F |
|
331 |
268 |
$0.00 |
| 3044F |
|
332 |
273 |
$0.00 |
| 1034F |
|
122 |
105 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
26 |
22 |
$0.00 |
| 4000F |
|
117 |
102 |
$0.00 |
| 90656 |
|
45 |
44 |
$0.00 |
| 3080F |
|
13 |
12 |
$0.00 |
| J3490 |
Unclassified drugs |
15 |
15 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
200 |
174 |
$0.00 |
| 3078F |
|
12,829 |
11,326 |
$0.00 |
| 4004F |
|
9,626 |
8,489 |
$0.00 |
| 1160F |
|
3,461 |
3,062 |
$0.00 |
| 1159F |
|
3,462 |
3,063 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
2,035 |
1,833 |
$0.00 |
| 3077F |
|
60 |
55 |
$0.00 |
| 3050F |
|
27 |
27 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
74 |
71 |
$0.00 |