| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,493 |
12,916 |
$1.26M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,534 |
8,074 |
$304K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,851 |
2,270 |
$110K |
| D1120 |
Prophylaxis - child |
2,096 |
1,728 |
$25K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,611 |
882 |
$24K |
| D1110 |
Prophylaxis - adult |
1,417 |
1,130 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,470 |
2,092 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,965 |
1,606 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,521 |
1,239 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
692 |
453 |
$15K |
| 90832 |
Psychotherapy, 30 minutes with patient |
546 |
195 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
489 |
393 |
$11K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,470 |
876 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
584 |
379 |
$9K |
| D0274 |
Bitewings - four radiographic images |
914 |
746 |
$9K |
| 90834 |
Psychotherapy, 45 minutes with patient |
356 |
168 |
$9K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,223 |
683 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
1,024 |
770 |
$7K |
| D0272 |
Bitewings - two radiographic images |
586 |
537 |
$5K |
| 90686 |
|
880 |
560 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
431 |
261 |
$4K |
| 92551 |
|
872 |
539 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,483 |
1,115 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
67 |
46 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
40 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
103 |
57 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
256 |
144 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
514 |
161 |
$1K |
| 87807 |
|
226 |
144 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
154 |
88 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
43 |
$925.00 |
| 99174 |
|
782 |
492 |
$832.51 |
| S9470 |
Nutritional counseling, dietitian visit |
6,759 |
3,865 |
$661.82 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
258 |
135 |
$631.85 |
| 90651 |
|
18 |
12 |
$554.70 |
| D2330 |
|
22 |
13 |
$398.61 |
| 1003F |
|
553 |
501 |
$278.83 |
| 90656 |
|
13 |
12 |
$224.62 |
| 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 |
210 |
179 |
$220.00 |
| 99173 |
|
170 |
93 |
$214.08 |
| 1000F |
|
1,109 |
801 |
$149.89 |
| 3074F |
|
2,174 |
1,188 |
$149.47 |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$83.60 |
| 99406 |
|
2,384 |
1,146 |
$28.19 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
15 |
12 |
$3.46 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
451 |
261 |
$2.17 |
| 3078F |
|
1,946 |
1,078 |
$0.79 |
| 3079F |
|
924 |
470 |
$0.35 |
| 1125F |
|
2,233 |
1,202 |
$0.21 |
| 1126F |
|
2,138 |
1,158 |
$0.14 |
| 99408 |
|
2,783 |
1,386 |
$0.10 |
| 3075F |
|
211 |
102 |
$0.06 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
1,922 |
1,128 |
$0.04 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
8,689 |
4,838 |
$0.03 |
| 3077F |
|
33 |
17 |
$0.02 |
| 1159F |
|
2,050 |
1,228 |
$0.01 |
| 1111F |
|
1,285 |
679 |
$0.01 |
| 3725F |
|
426 |
276 |
$0.00 |
| 1160F |
|
543 |
460 |
$0.00 |
| 4004F |
|
139 |
93 |
$0.00 |
| G8476 |
Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
705 |
384 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
65 |
46 |
$0.00 |
| 2014F |
|
83 |
74 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
41 |
14 |
$0.00 |
| 1036F |
|
129 |
113 |
$0.00 |
| H0001 |
Alcohol and/or drug assessment |
174 |
118 |
$0.00 |
| D0603 |
|
16 |
12 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
14 |
13 |
$0.00 |
| 94760 |
|
27 |
13 |
$0.00 |