| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,148 |
4,007 |
$1.01M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,077 |
22,020 |
$444K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,049 |
7,318 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
704 |
621 |
$109K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,128 |
1,108 |
$41K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,080 |
3,809 |
$40K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,688 |
2,584 |
$39K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
793 |
778 |
$29K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
704 |
683 |
$24K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
589 |
579 |
$22K |
| 90677 |
|
152 |
142 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,503 |
1,465 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
345 |
336 |
$14K |
| 0012A |
|
346 |
346 |
$12K |
| 0011A |
|
352 |
352 |
$10K |
| 90651 |
|
208 |
203 |
$7K |
| 90697 |
|
41 |
40 |
$5K |
| 90686 |
|
1,023 |
974 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
161 |
156 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
73 |
67 |
$3K |
| 0064A |
|
61 |
61 |
$2K |
| 90632 |
|
22 |
22 |
$2K |
| 0134A |
|
60 |
58 |
$2K |
| 90670 |
|
179 |
170 |
$2K |
| 0004A |
|
39 |
39 |
$2K |
| 90734 |
|
124 |
123 |
$1K |
| 90480 |
|
38 |
38 |
$1K |
| 0124A |
|
54 |
52 |
$1K |
| 0071A |
|
39 |
39 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
29 |
$1K |
| 90620 |
|
37 |
37 |
$1K |
| 90656 |
|
213 |
213 |
$963.78 |
| 0072A |
|
26 |
26 |
$961.68 |
| 93000 |
|
98 |
93 |
$888.45 |
| 90474 |
|
80 |
79 |
$863.57 |
| 99385 |
|
26 |
26 |
$784.01 |
| 99383 |
|
44 |
39 |
$737.16 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,430 |
968 |
$631.82 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
43 |
40 |
$585.00 |
| D0140 |
Limited oral evaluation - problem focused |
853 |
841 |
$575.00 |
| D0330 |
Panoramic radiographic image |
765 |
758 |
$505.50 |
| 94375 |
|
27 |
24 |
$436.02 |
| 0051A |
|
12 |
12 |
$434.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
699 |
699 |
$375.00 |
| 81000 |
|
337 |
255 |
$353.46 |
| 90461 |
|
33 |
33 |
$312.55 |
| 90710 |
|
15 |
15 |
$295.37 |
| 90633 |
|
117 |
115 |
$174.20 |
| D0220 |
Intraoral - periapical first radiographic image |
783 |
763 |
$163.50 |
| 3074F |
|
16,425 |
14,783 |
$149.06 |
| 90715 |
|
53 |
52 |
$140.16 |
| 3078F |
|
15,106 |
13,673 |
$133.03 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
23 |
22 |
$122.81 |
| 90696 |
|
25 |
25 |
$122.26 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
80 |
79 |
$103.14 |
| 99173 |
|
258 |
255 |
$102.28 |
| 90680 |
|
14 |
14 |
$92.44 |
| D0274 |
Bitewings - four radiographic images |
221 |
217 |
$80.00 |
| 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 |
163 |
133 |
$71.40 |
| 91301 |
|
689 |
668 |
$67.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
588 |
473 |
$58.50 |
| 3079F |
|
3,075 |
2,896 |
$40.03 |
| 91322 |
|
39 |
37 |
$29.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
59 |
58 |
$28.93 |
| 3077F |
|
1,303 |
1,204 |
$27.00 |
| 82947 |
|
59 |
55 |
$24.00 |
| 3080F |
|
993 |
900 |
$16.00 |
| 83655 |
|
24 |
24 |
$15.00 |
| 3075F |
|
1,534 |
1,452 |
$11.00 |
| 91306 |
|
54 |
54 |
$5.00 |
| 91307 |
|
108 |
102 |
$5.00 |
| 91305 |
|
72 |
67 |
$3.00 |
| 91312 |
|
52 |
51 |
$2.00 |
| 94760 |
|
61 |
57 |
$1.32 |
| 85018 |
|
12 |
12 |
$1.00 |
| 91313 |
|
46 |
44 |
$1.00 |
| 91300 |
|
114 |
107 |
$1.00 |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
63 |
56 |
$0.00 |
| 00000 |
|
20 |
20 |
$0.00 |
| 90723 |
|
13 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
12 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
16 |
13 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
210 |
208 |
$0.00 |
| 81025 |
|
14 |
12 |
$0.00 |
| 0502F |
|
247 |
189 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
57 |
52 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
14 |
12 |
$0.00 |
| 99201 |
|
12 |
12 |
$0.00 |