| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
128,642 |
90,506 |
$18.28M |
| D0999 |
Unspecified diagnostic procedure, by report |
12,927 |
11,349 |
$1.49M |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
447 |
275 |
$424K |
| 59514 |
|
109 |
67 |
$104K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,163 |
967 |
$81K |
| 90715 |
|
711 |
614 |
$3K |
| 90674 |
|
256 |
163 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43,089 |
32,853 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
9,319 |
7,730 |
$2K |
| 90710 |
|
74 |
64 |
$2K |
| 90688 |
|
239 |
172 |
$2K |
| 0011A |
|
17 |
16 |
$686.42 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19,988 |
16,430 |
$663.35 |
| 90682 |
|
62 |
53 |
$560.10 |
| 0012A |
|
12 |
12 |
$490.70 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
2,148 |
1,787 |
$435.20 |
| 0502F |
|
10,148 |
5,932 |
$308.70 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
6,157 |
5,403 |
$290.32 |
| 90734 |
|
62 |
58 |
$222.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,176 |
2,894 |
$166.40 |
| 90633 |
|
622 |
601 |
$153.72 |
| G0008 |
Administration of influenza virus vaccine |
989 |
797 |
$153.60 |
| 99441 |
|
3,923 |
3,685 |
$144.34 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,399 |
3,053 |
$133.82 |
| D1206 |
Topical application of fluoride varnish |
3,435 |
3,363 |
$102.63 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,081 |
924 |
$102.63 |
| 81002 |
|
24,438 |
14,573 |
$41.60 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
214 |
168 |
$33.70 |
| 81025 |
|
9,287 |
7,897 |
$5.16 |
| 99442 |
|
5,941 |
5,075 |
$1.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
272 |
$0.00 |
| D0601 |
|
728 |
706 |
$0.00 |
| 99381 |
|
691 |
654 |
$0.00 |
| D0603 |
|
1,127 |
1,095 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,591 |
3,515 |
$0.00 |
| 90647 |
|
46 |
45 |
$0.00 |
| 90677 |
|
380 |
365 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
202 |
196 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,473 |
2,449 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,733 |
1,687 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,257 |
2,993 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,149 |
960 |
$0.00 |
| 90698 |
|
383 |
372 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,653 |
1,176 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
276 |
$0.00 |
| 88142 |
|
212 |
178 |
$0.00 |
| 0500F |
|
26 |
26 |
$0.00 |
| 90697 |
|
576 |
552 |
$0.00 |
| D1351 |
Sealant - per tooth |
305 |
175 |
$0.00 |
| 99443 |
|
1,718 |
1,345 |
$0.00 |
| 90716 |
|
123 |
121 |
$0.00 |
| 90686 |
|
655 |
620 |
$0.00 |
| 90651 |
|
357 |
341 |
$0.00 |
| 99383 |
|
226 |
225 |
$0.00 |
| D0602 |
|
415 |
398 |
$0.00 |
| 90656 |
|
100 |
98 |
$0.00 |
| 99384 |
|
193 |
190 |
$0.00 |
| 99000 |
|
109 |
97 |
$0.00 |
| 90744 |
|
126 |
120 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
52 |
51 |
$0.00 |
| 90696 |
|
25 |
25 |
$0.00 |
| 90723 |
|
14 |
12 |
$0.00 |
| 88738 |
|
90 |
58 |
$0.00 |
| 90619 |
|
28 |
28 |
$0.00 |
| 90620 |
|
42 |
40 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,626 |
1,586 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,991 |
1,926 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,561 |
1,494 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
455 |
437 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,129 |
3,241 |
$0.00 |
| D4341 |
|
117 |
75 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,267 |
3,200 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,728 |
1,636 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,461 |
1,438 |
$0.00 |
| D0270 |
|
317 |
315 |
$0.00 |
| 90681 |
|
645 |
615 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,079 |
1,078 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,260 |
1,228 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
2,747 |
2,139 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
587 |
543 |
$0.00 |
| 90670 |
|
659 |
631 |
$0.00 |
| 90707 |
|
69 |
64 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
713 |
500 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
17 |
13 |
$0.00 |