| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
20,730 |
15,153 |
$3.18M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,899 |
1,621 |
$239K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
117 |
67 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
471 |
384 |
$72.97 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,976 |
9,475 |
$37.00 |
| 90686 |
|
290 |
286 |
$19.20 |
| 96127 |
|
3,536 |
2,838 |
$18.60 |
| D0274 |
Bitewings - four radiographic images |
147 |
146 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
256 |
237 |
$0.00 |
| D1120 |
Prophylaxis - child |
249 |
248 |
$0.00 |
| 3077F |
|
533 |
495 |
$0.00 |
| 0502F |
|
1,282 |
769 |
$0.00 |
| 3078F |
|
4,466 |
3,732 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
175 |
168 |
$0.00 |
| 1160F |
|
6,483 |
5,294 |
$0.00 |
| 3725F |
|
4,670 |
4,014 |
$0.00 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
859 |
500 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
934 |
878 |
$0.00 |
| 90461 |
|
384 |
369 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
411 |
378 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
153 |
126 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
129 |
127 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
92 |
87 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
165 |
161 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
43 |
38 |
$0.00 |
| 90715 |
|
54 |
54 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
24 |
24 |
$0.00 |
| 90648 |
|
13 |
12 |
$0.00 |
| 3008F |
|
7,259 |
6,056 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
387 |
379 |
$0.00 |
| 1126F |
|
652 |
576 |
$0.00 |
| 3074F |
|
4,932 |
4,056 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
604 |
583 |
$0.00 |
| 3079F |
|
1,424 |
1,299 |
$0.00 |
| 1036F |
|
6,550 |
5,195 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
459 |
436 |
$0.00 |
| 3075F |
|
644 |
616 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
298 |
276 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
197 |
$0.00 |
| 90677 |
|
117 |
115 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
96 |
$0.00 |
| 3080F |
|
77 |
70 |
$0.00 |
| 90656 |
|
102 |
98 |
$0.00 |
| 90680 |
|
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
19 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| 90732 |
|
12 |
12 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
17 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |