| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
64,816 |
50,508 |
$5.04M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
63,023 |
31,348 |
$1.39M |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
32,871 |
7,475 |
$243K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,755 |
3,166 |
$180K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
7,421 |
3,929 |
$171K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,191 |
1,672 |
$101K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,779 |
952 |
$87K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,410 |
1,791 |
$78K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,704 |
1,844 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,422 |
583 |
$62K |
| D1110 |
Prophylaxis - adult |
2,566 |
1,704 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
869 |
468 |
$39K |
| T2003 |
Non-emergency transportation; encounter/trip |
4,457 |
1,880 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,667 |
1,792 |
$34K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
724 |
419 |
$24K |
| 36415 |
Collection of venous blood by venipuncture |
13,175 |
7,221 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,958 |
1,180 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
2,157 |
1,291 |
$23K |
| 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 |
2,105 |
877 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,984 |
1,308 |
$21K |
| D1120 |
Prophylaxis - child |
1,642 |
1,046 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,759 |
1,196 |
$18K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,281 |
1,240 |
$17K |
| D0330 |
Panoramic radiographic image |
898 |
535 |
$16K |
| 99381 |
|
593 |
355 |
$15K |
| 92551 |
|
3,586 |
2,032 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,648 |
953 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
176 |
105 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
3,092 |
1,925 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
209 |
185 |
$9K |
| 59430 |
|
110 |
74 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
248 |
140 |
$8K |
| 90686 |
|
3,054 |
1,589 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
328 |
181 |
$7K |
| 81025 |
|
1,937 |
1,064 |
$6K |
| 90837 |
Psychotherapy, 53 minutes with patient |
96 |
37 |
$6K |
| 99173 |
|
3,506 |
1,987 |
$5K |
| 85018 |
|
4,602 |
2,539 |
$4K |
| 99442 |
|
427 |
235 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,205 |
684 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
990 |
382 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
499 |
290 |
$3K |
| 36416 |
|
1,313 |
848 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
37 |
$3K |
| 11721 |
|
170 |
123 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
61 |
39 |
$2K |
| 80305 |
|
546 |
254 |
$2K |
| 92015 |
Determination of refractive state |
208 |
183 |
$2K |
| 99441 |
|
244 |
130 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
25 |
$922.36 |
| 90656 |
|
477 |
469 |
$921.52 |
| 90677 |
|
2,412 |
1,375 |
$865.98 |
| D0272 |
Bitewings - two radiographic images |
166 |
103 |
$630.00 |
| 99459 |
|
63 |
62 |
$523.41 |
| 81003 |
|
650 |
369 |
$508.60 |
| 0134A |
|
14 |
14 |
$489.58 |
| 3077F |
|
300 |
208 |
$475.00 |
| 3079F |
|
765 |
618 |
$375.01 |
| D0240 |
|
50 |
18 |
$360.00 |
| 90715 |
|
20 |
12 |
$300.26 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
12 |
12 |
$295.68 |
| 87210 |
|
174 |
81 |
$290.32 |
| 3074F |
|
3,534 |
2,772 |
$280.00 |
| 90670 |
|
3,765 |
2,041 |
$267.99 |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
17 |
$240.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$225.36 |
| 90658 |
|
13 |
13 |
$196.74 |
| 3008F |
|
1,836 |
1,602 |
$170.00 |
| 3044F |
|
172 |
117 |
$160.11 |
| 82962 |
|
124 |
75 |
$133.03 |
| 3046F |
|
478 |
285 |
$110.12 |
| 90633 |
|
2,097 |
1,188 |
$103.76 |
| 90698 |
|
2,788 |
1,508 |
$85.33 |
| 3080F |
|
47 |
39 |
$80.00 |
| 3078F |
|
2,691 |
2,130 |
$65.00 |
| 81002 |
|
38 |
13 |
$36.54 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$22.16 |
| 3075F |
|
15 |
13 |
$15.00 |
| 90744 |
|
1,508 |
829 |
$10.00 |
| 91313 |
|
14 |
14 |
$0.13 |
| 90681 |
|
2,664 |
1,452 |
$0.00 |
| 0502F |
|
969 |
725 |
$0.00 |
| 90707 |
|
273 |
164 |
$0.00 |
| 90700 |
|
52 |
42 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
143 |
73 |
$0.00 |
| 90648 |
|
31 |
30 |
$0.00 |
| V2025 |
Deluxe frame |
77 |
73 |
$0.00 |
| 90710 |
|
58 |
36 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
116 |
66 |
$0.00 |
| 4004F |
|
19 |
13 |
$0.00 |
| 90716 |
|
337 |
195 |
$0.00 |
| 3351F |
|
1,376 |
1,036 |
$0.00 |
| 90697 |
|
2,451 |
1,346 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
273 |
160 |
$0.00 |
| 1123F |
|
246 |
86 |
$0.00 |
| 1111F |
|
45 |
24 |
$0.00 |
| 0503F |
|
116 |
105 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
92 |
46 |
$0.00 |
| 3352F |
|
78 |
72 |
$0.00 |
| 0500F |
|
23 |
21 |
$0.00 |
| 2023F |
|
28 |
26 |
$0.00 |