| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
93,607 |
70,540 |
$12.94M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
47,650 |
39,258 |
$6K |
| 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 |
10,429 |
8,120 |
$2K |
| D1120 |
Prophylaxis - child |
5,821 |
5,484 |
$2K |
| D1206 |
Topical application of fluoride varnish |
6,354 |
6,006 |
$812.28 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
49,225 |
38,160 |
$699.45 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,628 |
1,439 |
$510.72 |
| D0120 |
Periodic oral evaluation - established patient |
5,090 |
4,814 |
$489.06 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,380 |
914 |
$427.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,318 |
2,628 |
$297.70 |
| D0220 |
Intraoral - periapical first radiographic image |
5,201 |
4,639 |
$287.11 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,005 |
1,896 |
$239.34 |
| T1016 |
Case management, each 15 minutes |
15 |
15 |
$199.95 |
| D7140 |
Extraction, erupted tooth or exposed root |
827 |
461 |
$162.12 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
816 |
580 |
$141.84 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
10,507 |
9,302 |
$123.00 |
| D1351 |
Sealant - per tooth |
2,160 |
762 |
$52.50 |
| D0272 |
Bitewings - two radiographic images |
2,060 |
1,965 |
$46.62 |
| D0140 |
Limited oral evaluation - problem focused |
2,747 |
2,455 |
$35.94 |
| 3008F |
|
27,831 |
21,051 |
$27.21 |
| 81002 |
|
7,551 |
4,894 |
$24.31 |
| D0270 |
|
531 |
490 |
$11.69 |
| 36415 |
Collection of venous blood by venipuncture |
15,263 |
13,395 |
$4.74 |
| 3078F |
|
14,065 |
10,588 |
$3.57 |
| 90715 |
|
2,157 |
1,869 |
$2.82 |
| 85018 |
|
3,472 |
3,198 |
$2.43 |
| 1159F |
|
22,865 |
16,889 |
$2.01 |
| 81025 |
|
3,592 |
3,091 |
$1.24 |
| 1126F |
|
10,445 |
8,079 |
$1.07 |
| 96150 |
|
467 |
342 |
$1.06 |
| 36416 |
|
10,098 |
8,770 |
$0.96 |
| 96152 |
|
1,762 |
1,162 |
$0.74 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
833 |
750 |
$0.73 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,173 |
964 |
$0.67 |
| 90670 |
|
3,469 |
3,115 |
$0.46 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
255 |
216 |
$0.46 |
| 99381 |
|
817 |
767 |
$0.32 |
| 1125F |
|
10,709 |
8,144 |
$0.30 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
697 |
563 |
$0.26 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,884 |
3,550 |
$0.23 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
110 |
87 |
$0.18 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,237 |
2,968 |
$0.17 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,311 |
1,175 |
$0.15 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,736 |
4,218 |
$0.08 |
| 96154 |
|
235 |
179 |
$0.06 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,754 |
1,342 |
$0.03 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,738 |
1,590 |
$0.00 |
| 90681 |
|
1,491 |
1,337 |
$0.00 |
| 3016F |
|
5,455 |
3,529 |
$0.00 |
| 99173 |
|
3,929 |
3,667 |
$0.00 |
| 90633 |
|
1,780 |
1,586 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,061 |
1,006 |
$0.00 |
| 83037 |
|
3,378 |
2,928 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,395 |
3,930 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,932 |
1,667 |
$0.00 |
| 3015F |
|
722 |
585 |
$0.00 |
| D1354 |
|
2,911 |
1,047 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,101 |
1,022 |
$0.00 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
424 |
399 |
$0.00 |
| 90710 |
|
740 |
656 |
$0.00 |
| 72110 |
|
256 |
237 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,201 |
1,664 |
$0.00 |
| 0002A |
|
66 |
61 |
$0.00 |
| 71046 |
Radiologic examination, chest; 2 views |
1,076 |
937 |
$0.00 |
| 3045F |
|
299 |
176 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,595 |
2,325 |
$0.00 |
| 1160F |
|
3,516 |
2,703 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,289 |
1,156 |
$0.00 |
| 82465 |
|
850 |
777 |
$0.00 |
| D0330 |
Panoramic radiographic image |
734 |
712 |
$0.00 |
| 99177 |
|
535 |
508 |
$0.00 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
830 |
727 |
$0.00 |
| 0502F |
|
2,175 |
1,229 |
$0.00 |
| 90461 |
|
875 |
853 |
$0.00 |
| 96158 |
|
1,245 |
597 |
$0.00 |
| 83655 |
|
2,174 |
1,967 |
$0.00 |
| 3077F |
|
3,699 |
2,780 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
1,174 |
1,083 |
$0.00 |
| 90707 |
|
672 |
601 |
$0.00 |
| 90734 |
|
949 |
778 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,121 |
1,079 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
60 |
55 |
$0.00 |
| 0071A |
|
119 |
118 |
$0.00 |
| 92552 |
|
3,060 |
2,875 |
$0.00 |
| 91300 |
|
145 |
138 |
$0.00 |
| 90662 |
|
250 |
183 |
$0.00 |
| 85610 |
|
181 |
104 |
$0.00 |
| 2022F |
|
143 |
80 |
$0.00 |
| 73562 |
|
184 |
145 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
863 |
323 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
46 |
$0.00 |
| 80305 |
|
75 |
59 |
$0.00 |
| 69209 |
|
23 |
13 |
$0.00 |
| 90685 |
|
114 |
107 |
$0.00 |
| 4274F |
|
370 |
229 |
$0.00 |
| 90648 |
|
44 |
43 |
$0.00 |
| 69210 |
|
30 |
24 |
$0.00 |
| 3050F |
|
24 |
13 |
$0.00 |
| 0004A |
|
17 |
12 |
$0.00 |
| 3046F |
|
89 |
68 |
$0.00 |
| 73030 |
|
66 |
52 |
$0.00 |
| 73630 |
|
33 |
26 |
$0.00 |
| D0190 |
|
12 |
12 |
$0.00 |
| 59025 |
Fetal non-stress test |
85 |
39 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
108 |
101 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
30 |
16 |
$0.00 |
| 3079F |
|
5,788 |
4,545 |
$0.00 |
| 3074F |
|
14,958 |
11,348 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,421 |
2,239 |
$0.00 |
| 96156 |
|
921 |
694 |
$0.00 |
| 0001A |
|
80 |
78 |
$0.00 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
650 |
596 |
$0.00 |
| 91306 |
|
169 |
155 |
$0.00 |
| 96127 |
|
526 |
522 |
$0.00 |
| 76830 |
Ultrasound, transvaginal |
238 |
224 |
$0.00 |
| 3061F |
|
230 |
158 |
$0.00 |
| 90744 |
|
1,365 |
1,223 |
$0.00 |
| 90688 |
|
1,982 |
1,786 |
$0.00 |
| 90696 |
|
596 |
515 |
$0.00 |
| 88720 |
|
1,209 |
838 |
$0.00 |
| D0603 |
|
1,869 |
1,704 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,693 |
3,286 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
224 |
210 |
$0.00 |
| 3080F |
|
1,919 |
1,502 |
$0.00 |
| 90698 |
|
2,667 |
2,445 |
$0.00 |
| 76801 |
|
376 |
329 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,669 |
3,030 |
$0.00 |
| 3044F |
|
384 |
261 |
$0.00 |
| 90686 |
|
3,047 |
2,768 |
$0.00 |
| 82962 |
|
878 |
753 |
$0.00 |
| 0011A |
|
784 |
768 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
304 |
274 |
$0.00 |
| 4010F |
|
381 |
222 |
$0.00 |
| 3048F |
|
516 |
341 |
$0.00 |
| 0064A |
|
273 |
242 |
$0.00 |
| 3014F |
|
546 |
361 |
$0.00 |
| 3075F |
|
2,824 |
2,192 |
$0.00 |
| 58300 |
|
30 |
25 |
$0.00 |
| 90697 |
|
500 |
421 |
$0.00 |
| 4037F |
|
517 |
404 |
$0.00 |
| 91301 |
|
915 |
890 |
$0.00 |
| 90651 |
|
1,554 |
1,339 |
$0.00 |
| 91307 |
|
154 |
143 |
$0.00 |
| 0501F |
|
141 |
116 |
$0.00 |
| 1031F |
|
5,463 |
3,537 |
$0.00 |
| 92551 |
|
321 |
307 |
$0.00 |
| 86580 |
|
60 |
57 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
183 |
171 |
$0.00 |
| 90716 |
|
669 |
598 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
123 |
93 |
$0.00 |
| 3017F |
|
357 |
212 |
$0.00 |
| 90620 |
|
178 |
155 |
$0.00 |
| 99384 |
|
40 |
29 |
$0.00 |
| 90723 |
|
44 |
42 |
$0.00 |
| 99383 |
|
59 |
56 |
$0.00 |
| 1036F |
|
80 |
77 |
$0.00 |
| 0012A |
|
753 |
738 |
$0.00 |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
51 |
41 |
$0.00 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
141 |
108 |
$0.00 |
| 90680 |
|
134 |
128 |
$0.00 |
| 87807 |
|
466 |
406 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
160 |
135 |
$0.00 |
| 99386 |
|
12 |
12 |
$0.00 |
| 0072A |
|
98 |
97 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
274 |
185 |
$0.00 |
| 0503F |
|
45 |
41 |
$0.00 |
| 3049F |
|
20 |
12 |
$0.00 |
| 99000 |
|
30 |
27 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
29 |
15 |
$0.00 |
| 90619 |
|
27 |
25 |
$0.00 |
| 0134A |
|
16 |
14 |
$0.00 |
| 99385 |
|
20 |
15 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
23 |
$0.00 |
| 90732 |
|
35 |
28 |
$0.00 |
| 96161 |
|
18 |
14 |
$0.00 |
| 0031A |
|
13 |
13 |
$0.00 |