| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
57,538 |
49,039 |
$9.30M |
| D9450 |
|
68,926 |
33,253 |
$1.79M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
8,883 |
4,581 |
$1.19M |
| 90834 |
Psychotherapy, 45 minutes with patient |
8,890 |
4,674 |
$662K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,616 |
2,589 |
$430K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,397 |
17,357 |
$308K |
| D0330 |
Panoramic radiographic image |
11,068 |
6,038 |
$302K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,773 |
1,770 |
$289K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,732 |
1,727 |
$280K |
| D1110 |
Prophylaxis - adult |
15,808 |
12,544 |
$273K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,566 |
1,565 |
$253K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,449 |
1,075 |
$203K |
| 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 |
6,383 |
5,299 |
$191K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
2,155 |
2,145 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,256 |
1,449 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,061 |
6,686 |
$166K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
916 |
850 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
7,421 |
3,907 |
$156K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,882 |
5,757 |
$146K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,057 |
527 |
$131K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
2,286 |
1,332 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
13,979 |
7,307 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,871 |
3,375 |
$88K |
| 99173 |
|
4,535 |
4,356 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,301 |
5,538 |
$82K |
| D4341 |
|
2,086 |
996 |
$70K |
| D0274 |
Bitewings - four radiographic images |
7,574 |
5,782 |
$65K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,667 |
1,566 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
2,658 |
2,066 |
$60K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
6,371 |
6,104 |
$57K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
703 |
703 |
$56K |
| D1120 |
Prophylaxis - child |
1,161 |
1,084 |
$54K |
| 90662 |
|
871 |
867 |
$44K |
| 92551 |
|
4,683 |
4,510 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
4,979 |
3,762 |
$40K |
| 97802 |
|
678 |
678 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,205 |
1,148 |
$34K |
| 90715 |
|
1,291 |
1,255 |
$30K |
| 90832 |
Psychotherapy, 30 minutes with patient |
611 |
453 |
$30K |
| 97803 |
|
909 |
896 |
$27K |
| 0011A |
|
631 |
624 |
$25K |
| D2330 |
|
1,433 |
921 |
$23K |
| 0012A |
|
495 |
492 |
$23K |
| D2331 |
|
1,167 |
795 |
$22K |
| 99385 |
|
118 |
118 |
$20K |
| D9110 |
|
698 |
374 |
$17K |
| D2140 |
|
1,229 |
665 |
$17K |
| 99188 |
|
688 |
644 |
$16K |
| D0180 |
|
1,408 |
1,150 |
$16K |
| 90746 |
|
242 |
242 |
$16K |
| 90791 |
Psychiatric diagnostic evaluation |
99 |
95 |
$13K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
419 |
413 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
893 |
536 |
$13K |
| 90656 |
|
3,160 |
3,127 |
$13K |
| D5212 |
|
126 |
85 |
$13K |
| 92015 |
Determination of refractive state |
1,017 |
1,017 |
$12K |
| 0001A |
|
274 |
271 |
$12K |
| 0002A |
|
205 |
204 |
$9K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,047 |
4,881 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
928 |
886 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
230 |
$6K |
| 0064A |
|
155 |
155 |
$6K |
| 81025 |
|
970 |
925 |
$6K |
| D5211 |
|
65 |
42 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,939 |
3,857 |
$4K |
| 0004A |
|
75 |
75 |
$3K |
| 90686 |
|
207 |
206 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,527 |
1,478 |
$3K |
| 90670 |
|
242 |
226 |
$3K |
| 81000 |
|
869 |
765 |
$3K |
| 87210 |
|
543 |
535 |
$2K |
| 0072A |
|
41 |
41 |
$2K |
| 90651 |
|
466 |
445 |
$2K |
| 90750 |
|
26 |
26 |
$2K |
| 90882 |
|
33 |
30 |
$2K |
| 0071A |
|
31 |
31 |
$1K |
| 0134A |
|
28 |
27 |
$1K |
| D2160 |
|
48 |
31 |
$850.00 |
| 92250 |
|
39 |
39 |
$835.55 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$816.48 |
| 90673 |
|
15 |
15 |
$755.88 |
| 90707 |
|
30 |
29 |
$668.39 |
| 90461 |
|
1,527 |
1,470 |
$659.28 |
| G0466 |
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 |
12 |
12 |
$519.60 |
| 0031A |
|
12 |
12 |
$504.57 |
| D2332 |
|
12 |
12 |
$464.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$360.00 |
| 90633 |
|
241 |
236 |
$308.28 |
| D2335 |
|
16 |
12 |
$292.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
25 |
25 |
$198.78 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
22 |
22 |
$132.57 |
| 82947 |
|
12 |
12 |
$44.55 |
| 90744 |
|
163 |
154 |
$27.53 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
112 |
112 |
$20.55 |
| 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 |
24 |
24 |
$0.11 |
| G0008 |
Administration of influenza virus vaccine |
195 |
185 |
$0.00 |
| 91301 |
|
1,302 |
1,279 |
$0.00 |
| 90698 |
|
134 |
133 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
511 |
476 |
$0.00 |
| 99000 |
|
750 |
724 |
$0.00 |
| 90680 |
|
37 |
37 |
$0.00 |
| 90619 |
|
32 |
32 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
24 |
24 |
$0.00 |
| 91300 |
|
759 |
711 |
$0.00 |
| 90734 |
|
239 |
217 |
$0.00 |
| 90710 |
|
38 |
38 |
$0.00 |
| 90648 |
|
15 |
15 |
$0.00 |
| 91313 |
|
13 |
13 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$0.00 |