| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,126 |
22,507 |
$994K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,308 |
1,017 |
$216K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,002 |
3,387 |
$214K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,569 |
5,921 |
$141K |
| T1015 |
Clinic visit/encounter, all-inclusive |
15,063 |
12,515 |
$121K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,205 |
1,097 |
$105K |
| 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 |
4,416 |
3,465 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
849 |
568 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,450 |
1,218 |
$50K |
| D1110 |
Prophylaxis - adult |
1,044 |
916 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,396 |
1,173 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,106 |
798 |
$39K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
446 |
411 |
$37K |
| 90834 |
Psychotherapy, 45 minutes with patient |
566 |
399 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
867 |
723 |
$30K |
| D0330 |
Panoramic radiographic image |
867 |
686 |
$29K |
| 96158 |
|
1,307 |
614 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,370 |
1,182 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
518 |
313 |
$25K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
848 |
740 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,381 |
1,129 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
117 |
$13K |
| 90686 |
|
634 |
536 |
$9K |
| 96152 |
|
569 |
290 |
$8K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
591 |
146 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
974 |
259 |
$6K |
| 90688 |
|
536 |
492 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
155 |
137 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
555 |
516 |
$4K |
| 90715 |
|
112 |
88 |
$4K |
| D2331 |
|
38 |
27 |
$3K |
| D4910 |
|
67 |
54 |
$2K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
328 |
95 |
$2K |
| 96156 |
|
30 |
30 |
$2K |
| D2332 |
|
22 |
12 |
$1K |
| D2330 |
|
19 |
12 |
$1K |
| 90756 |
|
204 |
200 |
$1K |
| 81003 |
|
629 |
542 |
$983.10 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
121 |
109 |
$811.91 |
| 90656 |
|
46 |
44 |
$695.18 |
| 96150 |
|
14 |
13 |
$188.71 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
673 |
585 |
$69.89 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
160 |
142 |
$13.21 |
| 99173 |
|
16 |
16 |
$0.00 |
| 81025 |
|
15 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
19 |
19 |
$0.00 |
| 90658 |
|
16 |
16 |
$0.00 |
| 93000 |
|
12 |
12 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
13 |
12 |
$0.00 |
| 92551 |
|
13 |
13 |
$0.00 |
| 82962 |
|
15 |
14 |
$0.00 |