| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
229,966 |
209,190 |
$45.28M |
| 99499 |
|
12,037 |
11,423 |
$175K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
86,003 |
79,423 |
$49K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30,420 |
28,931 |
$22K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30,184 |
29,413 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
9,507 |
9,283 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
5,956 |
5,811 |
$3K |
| 3074F |
|
1,822 |
1,764 |
$3K |
| 92551 |
|
16,748 |
16,204 |
$2K |
| 3078F |
|
1,287 |
1,248 |
$2K |
| 3079F |
|
1,405 |
1,355 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14,244 |
13,911 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
8,003 |
7,838 |
$2K |
| 3077F |
|
706 |
681 |
$1K |
| 3075F |
|
594 |
577 |
$880.00 |
| 3080F |
|
351 |
339 |
$680.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
10,733 |
10,480 |
$501.02 |
| D0120 |
Periodic oral evaluation - established patient |
4,165 |
4,126 |
$455.06 |
| D1206 |
Topical application of fluoride varnish |
3,471 |
3,420 |
$371.61 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
947 |
741 |
$336.32 |
| 90651 |
|
3,392 |
3,282 |
$323.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,601 |
2,543 |
$286.09 |
| 90715 |
|
1,730 |
1,680 |
$233.73 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,042 |
817 |
$216.46 |
| 96127 |
|
7,767 |
7,558 |
$215.44 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,330 |
1,244 |
$213.57 |
| D1120 |
Prophylaxis - child |
2,258 |
2,231 |
$196.52 |
| 99383 |
|
38 |
38 |
$163.04 |
| 90698 |
|
7,262 |
7,094 |
$139.33 |
| 3044F |
|
56 |
55 |
$130.00 |
| 90686 |
|
15,884 |
15,260 |
$119.73 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
396 |
392 |
$115.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,269 |
1,257 |
$106.53 |
| D1110 |
Prophylaxis - adult |
2,618 |
2,588 |
$98.36 |
| 2022F |
|
27 |
27 |
$90.00 |
| D0274 |
Bitewings - four radiographic images |
1,800 |
1,776 |
$89.14 |
| 87210 |
|
1,351 |
1,306 |
$75.66 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,664 |
1,644 |
$70.94 |
| 4010F |
|
27 |
25 |
$60.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
349 |
346 |
$54.25 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,481 |
2,378 |
$52.48 |
| 83655 |
|
3,276 |
3,207 |
$40.00 |
| 3046F |
|
13 |
13 |
$40.00 |
| 81025 |
|
1,782 |
1,740 |
$38.00 |
| 99173 |
|
20,666 |
20,032 |
$26.23 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,605 |
3,512 |
$22.15 |
| D0272 |
Bitewings - two radiographic images |
933 |
920 |
$21.72 |
| 92552 |
|
1,650 |
1,634 |
$21.29 |
| 96161 |
|
4,552 |
4,458 |
$20.87 |
| 99188 |
|
3,004 |
2,929 |
$16.46 |
| 90474 |
|
2,512 |
2,476 |
$11.50 |
| 90734 |
|
1,750 |
1,682 |
$10.00 |
| 90633 |
|
5,113 |
4,933 |
$10.00 |
| 85018 |
|
3,801 |
3,705 |
$9.69 |
| 93000 |
|
26 |
26 |
$8.50 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
5,232 |
4,652 |
$7.04 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
3,242 |
3,040 |
$6.03 |
| 81002 |
|
1,676 |
1,587 |
$3.57 |
| 3008F |
|
5,126 |
4,807 |
$0.00 |
| 90680 |
|
3,420 |
3,371 |
$0.00 |
| 90744 |
|
2,752 |
2,697 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
403 |
389 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,506 |
1,477 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,555 |
1,499 |
$0.00 |
| 1036F |
|
5,953 |
5,476 |
$0.00 |
| 86580 |
|
131 |
118 |
$0.00 |
| 90656 |
|
194 |
193 |
$0.00 |
| D1330 |
|
3,215 |
3,179 |
$0.00 |
| 90619 |
|
870 |
868 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,196 |
758 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
168 |
$0.00 |
| D1310 |
|
388 |
371 |
$0.00 |
| 90716 |
|
997 |
951 |
$0.00 |
| 90677 |
|
457 |
457 |
$0.00 |
| D9995 |
|
442 |
439 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,531 |
656 |
$0.00 |
| D0601 |
|
353 |
350 |
$0.00 |
| D0602 |
|
257 |
255 |
$0.00 |
| 90696 |
|
1,174 |
1,147 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
564 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
81 |
80 |
$0.00 |
| 90732 |
|
25 |
25 |
$0.00 |
| D0603 |
|
292 |
283 |
$0.00 |
| 99441 |
|
14 |
13 |
$0.00 |
| 99381 |
|
472 |
467 |
$0.00 |
| 99385 |
|
266 |
258 |
$0.00 |
| D2330 |
|
22 |
14 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$0.00 |
| 1111F |
|
14 |
13 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
34 |
34 |
$0.00 |
| 99406 |
|
78 |
78 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
90 |
88 |
$0.00 |
| 58300 |
|
13 |
12 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
33 |
32 |
$0.00 |
| D2331 |
|
32 |
26 |
$0.00 |
| D5899 |
|
23 |
18 |
$0.00 |
| 76801 |
|
15 |
15 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,273 |
1,241 |
$0.00 |
| 90710 |
|
1,336 |
1,308 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
1,380 |
1,257 |
$0.00 |
| 90670 |
|
7,197 |
7,011 |
$0.00 |
| 90707 |
|
989 |
942 |
$0.00 |
| 90682 |
|
1,236 |
1,212 |
$0.00 |
| 99051 |
|
665 |
649 |
$0.00 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
151 |
138 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,044 |
1,994 |
$0.00 |
| D0330 |
Panoramic radiographic image |
759 |
752 |
$0.00 |
| 91312 |
|
27 |
27 |
$0.00 |
| 0124A |
|
107 |
107 |
$0.00 |
| D0190 |
|
74 |
74 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
320 |
281 |
$0.00 |
| D0270 |
|
57 |
55 |
$0.00 |
| 3725F |
|
1,014 |
968 |
$0.00 |
| 90461 |
|
1,418 |
1,378 |
$0.00 |
| 59025 |
Fetal non-stress test |
146 |
76 |
$0.00 |
| T1001 |
Nursing assessment / evaluation |
214 |
213 |
$0.00 |
| D0191 |
|
27 |
27 |
$0.00 |
| D1354 |
|
128 |
91 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
124 |
$0.00 |
| D9110 |
|
130 |
127 |
$0.00 |
| 90621 |
|
324 |
318 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
107 |
107 |
$0.00 |
| 4004F |
|
381 |
371 |
$0.00 |
| 99442 |
|
164 |
149 |
$0.00 |
| 90662 |
|
17 |
17 |
$0.00 |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
12 |
12 |
$0.00 |
| G9920 |
Screening performed and negative |
13 |
13 |
$0.00 |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
13 |
13 |
$0.00 |