| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
408,840 |
301,283 |
$56.11M |
| D0999 |
Unspecified diagnostic procedure, by report |
27,862 |
24,801 |
$2.62M |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
1,877 |
1,080 |
$1.69M |
| 59514 |
|
791 |
477 |
$828K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
906 |
736 |
$455K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
3,568 |
2,728 |
$276K |
| 99234 |
|
1,882 |
918 |
$110K |
| D1120 |
Prophylaxis - child |
7,420 |
7,272 |
$108K |
| D0274 |
Bitewings - four radiographic images |
5,196 |
5,014 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,261 |
2,074 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,743 |
2,700 |
$39K |
| 54150 |
|
461 |
304 |
$35K |
| 90651 |
|
7,260 |
6,322 |
$32K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
1,104 |
871 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
8,480 |
8,267 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,548 |
1,437 |
$29K |
| 99460 |
|
685 |
586 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
2,613 |
2,555 |
$24K |
| J7298 |
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
68 |
56 |
$23K |
| 90734 |
|
5,393 |
4,432 |
$23K |
| 59430 |
|
453 |
401 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,600 |
1,378 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
483 |
467 |
$14K |
| 90710 |
|
4,800 |
4,160 |
$13K |
| 0124A |
|
280 |
259 |
$11K |
| 90670 |
|
11,967 |
10,523 |
$7K |
| 90620 |
|
2,330 |
1,971 |
$7K |
| 90716 |
|
4,104 |
3,587 |
$7K |
| 0011A |
|
140 |
140 |
$6K |
| 91320 |
|
54 |
52 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
624 |
588 |
$6K |
| 0500F |
|
3,118 |
2,838 |
$5K |
| 99000 |
|
194 |
181 |
$4K |
| 90633 |
|
8,869 |
7,752 |
$4K |
| 0503F |
|
1,257 |
975 |
$4K |
| D1206 |
Topical application of fluoride varnish |
8,911 |
8,732 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
4,290 |
3,654 |
$4K |
| 90696 |
|
4,478 |
3,918 |
$4K |
| D2140 |
|
488 |
469 |
$4K |
| 90649 |
|
1,042 |
852 |
$4K |
| 90715 |
|
7,357 |
6,480 |
$3K |
| 90707 |
|
3,895 |
3,413 |
$3K |
| D1110 |
Prophylaxis - adult |
145 |
145 |
$2K |
| 99218 |
|
37 |
28 |
$2K |
| 90686 |
|
12,405 |
10,200 |
$2K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
100 |
53 |
$2K |
| 90480 |
|
34 |
33 |
$1K |
| 90723 |
|
10,888 |
9,671 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
202,935 |
167,041 |
$986.84 |
| 90700 |
|
3,625 |
3,109 |
$920.67 |
| 90647 |
|
10,703 |
9,389 |
$897.98 |
| 98960 |
|
172 |
52 |
$772.20 |
| 90680 |
|
7,616 |
6,754 |
$652.04 |
| 0064A |
|
14 |
14 |
$547.82 |
| 90744 |
|
500 |
427 |
$510.72 |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
160 |
$509.75 |
| 99070 |
|
13 |
13 |
$455.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12,349 |
11,993 |
$449.54 |
| 99383 |
|
1,261 |
1,165 |
$386.40 |
| 11982 |
|
145 |
122 |
$346.50 |
| 99401 |
|
9,110 |
2,407 |
$308.51 |
| D2331 |
|
14 |
13 |
$305.85 |
| 90713 |
|
414 |
342 |
$299.68 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,962 |
3,802 |
$256.31 |
| D0603 |
|
8,473 |
8,273 |
$227.34 |
| D1354 |
|
131 |
110 |
$215.62 |
| 93000 |
|
3,055 |
2,815 |
$139.94 |
| D0272 |
Bitewings - two radiographic images |
2,200 |
2,178 |
$113.67 |
| D0270 |
|
2,165 |
2,115 |
$113.15 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
32,251 |
28,257 |
$113.14 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
23,470 |
21,329 |
$112.51 |
| D1351 |
Sealant - per tooth |
533 |
356 |
$101.95 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,101 |
14,651 |
$85.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15,456 |
14,160 |
$76.84 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
738 |
646 |
$71.90 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
3,395 |
3,163 |
$67.20 |
| 58300 |
|
119 |
96 |
$44.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
5,806 |
5,320 |
$42.50 |
| 99201 |
|
768 |
667 |
$29.55 |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,479 |
9,611 |
$26.60 |
| 96127 |
|
8,266 |
7,397 |
$10.00 |
| 81025 |
|
14,739 |
13,063 |
$2.58 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,405 |
1,268 |
$1.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
12,076 |
8,495 |
$0.00 |
| 59025 |
Fetal non-stress test |
5,420 |
2,058 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
16,971 |
15,329 |
$0.00 |
| 86703 |
|
2,822 |
2,646 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
16,184 |
14,293 |
$0.00 |
| 90681 |
|
1,012 |
898 |
$0.00 |
| 81002 |
|
10,451 |
9,818 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
5,975 |
5,082 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
4,332 |
3,993 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
10,785 |
9,878 |
$0.00 |
| 96160 |
|
3,974 |
3,463 |
$0.00 |
| 0502F |
|
20,862 |
11,773 |
$0.00 |
| 99382 |
|
597 |
539 |
$0.00 |
| 11981 |
|
291 |
244 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
9,370 |
9,016 |
$0.00 |
| 3078F |
|
617 |
591 |
$0.00 |
| 3077F |
|
1,062 |
1,016 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
230 |
225 |
$0.00 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
14 |
13 |
$0.00 |
| 90380 |
|
45 |
43 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
20 |
15 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
14 |
13 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
727 |
647 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
3,787 |
1,984 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
2,203 |
1,342 |
$0.00 |
| 87428 |
|
3,453 |
3,345 |
$0.00 |
| 99384 |
|
573 |
530 |
$0.00 |
| 3079F |
|
837 |
808 |
$0.00 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,337 |
1,201 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,330 |
2,242 |
$0.00 |
| 90619 |
|
2,682 |
2,511 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,887 |
1,242 |
$0.00 |
| 99381 |
|
2,662 |
2,518 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,768 |
1,721 |
$0.00 |
| 3080F |
|
800 |
767 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
726 |
654 |
$0.00 |
| 3075F |
|
528 |
514 |
$0.00 |
| 90677 |
|
1,963 |
1,858 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
750 |
728 |
$0.00 |
| 86580 |
|
331 |
273 |
$0.00 |
| 90732 |
|
117 |
111 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
55 |
54 |
$0.00 |
| 3074F |
|
657 |
633 |
$0.00 |
| D1330 |
|
1,092 |
940 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
238 |
199 |
$0.00 |
| 76801 |
|
169 |
149 |
$0.00 |
| D0601 |
|
280 |
279 |
$0.00 |
| 76830 |
Ultrasound, transvaginal |
118 |
74 |
$0.00 |
| 99385 |
|
141 |
125 |
$0.00 |
| D2160 |
|
39 |
39 |
$0.00 |
| 90381 |
|
46 |
39 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
115 |
106 |
$0.00 |
| 90656 |
|
1,159 |
1,054 |
$0.00 |
| 3044F |
|
34 |
34 |
$0.00 |
| 94760 |
|
18 |
14 |
$0.00 |
| 99402 |
|
95 |
24 |
$0.00 |