| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
75,453 |
57,741 |
$9.88M |
| D0999 |
Unspecified diagnostic procedure, by report |
4,587 |
4,088 |
$477K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
2,390 |
1,762 |
$187K |
| 90716 |
|
205 |
199 |
$120.81 |
| 90686 |
|
1,963 |
1,661 |
$119.78 |
| D1120 |
Prophylaxis - child |
1,531 |
1,509 |
$84.05 |
| 90707 |
|
196 |
189 |
$71.18 |
| D1206 |
Topical application of fluoride varnish |
1,782 |
1,754 |
$53.30 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,173 |
3,786 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,950 |
1,908 |
$0.00 |
| 90651 |
|
694 |
651 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,634 |
1,599 |
$0.00 |
| 90647 |
|
1,500 |
1,335 |
$0.00 |
| D0603 |
|
1,910 |
1,870 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,385 |
7,355 |
$0.00 |
| 90680 |
|
848 |
798 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
31,398 |
25,285 |
$0.00 |
| 0500F |
|
432 |
411 |
$0.00 |
| 90696 |
|
339 |
327 |
$0.00 |
| 90723 |
|
1,424 |
1,308 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
339 |
247 |
$0.00 |
| 90619 |
|
303 |
294 |
$0.00 |
| D1330 |
|
1,017 |
931 |
$0.00 |
| 99381 |
|
102 |
99 |
$0.00 |
| 90656 |
|
84 |
83 |
$0.00 |
| 96127 |
|
808 |
784 |
$0.00 |
| 90677 |
|
282 |
282 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
388 |
341 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
189 |
189 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
84 |
83 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
234 |
$0.00 |
| 99383 |
|
132 |
132 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
400 |
273 |
$0.00 |
| 3074F |
|
28 |
28 |
$0.00 |
| 90732 |
|
26 |
26 |
$0.00 |
| 99384 |
|
49 |
49 |
$0.00 |
| 93000 |
|
30 |
30 |
$0.00 |
| 3079F |
|
30 |
30 |
$0.00 |
| D0601 |
|
30 |
29 |
$0.00 |
| 87428 |
|
112 |
110 |
$0.00 |
| D1351 |
Sealant - per tooth |
44 |
31 |
$0.00 |
| 90620 |
|
19 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
14 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,601 |
1,451 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,386 |
1,297 |
$0.00 |
| 90715 |
|
796 |
740 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,261 |
2,874 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,070 |
2,026 |
$0.00 |
| 90670 |
|
1,763 |
1,576 |
$0.00 |
| 0502F |
|
3,505 |
2,478 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,189 |
3,833 |
$0.00 |
| 90633 |
|
1,213 |
1,107 |
$0.00 |
| 99401 |
|
443 |
197 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,481 |
2,193 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
1,651 |
1,331 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,692 |
2,383 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,016 |
984 |
$0.00 |
| 96160 |
|
514 |
491 |
$0.00 |
| 90734 |
|
520 |
443 |
$0.00 |
| 90710 |
|
321 |
307 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,427 |
3,115 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,751 |
1,638 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
407 |
330 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
54 |
54 |
$0.00 |
| 90700 |
|
129 |
124 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
280 |
242 |
$0.00 |
| 59025 |
Fetal non-stress test |
16 |
14 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
50 |
$0.00 |
| 81002 |
|
19 |
16 |
$0.00 |
| N1351 |
|
13 |
13 |
$0.00 |
| 81025 |
|
26 |
24 |
$0.00 |
| 86703 |
|
26 |
26 |
$0.00 |
| 90681 |
|
39 |
39 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |
| 99382 |
|
15 |
15 |
$0.00 |