| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
77,881 |
70,325 |
$10.84M |
| D9450 |
|
63,792 |
42,015 |
$1.72M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
5,319 |
3,194 |
$733K |
| 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 |
11,131 |
8,988 |
$359K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,312 |
2,306 |
$287K |
| 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 |
2,010 |
1,523 |
$262K |
| D1110 |
Prophylaxis - adult |
11,342 |
8,352 |
$259K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,267 |
1,845 |
$247K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,791 |
1,786 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
16,410 |
12,921 |
$199K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,500 |
1,457 |
$196K |
| D0274 |
Bitewings - four radiographic images |
10,975 |
8,564 |
$192K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
8,459 |
8,353 |
$184K |
| D0220 |
Intraoral - periapical first radiographic image |
18,230 |
10,887 |
$178K |
| D0210 |
Intraoral - complete series of radiographic images |
6,721 |
5,030 |
$177K |
| D1120 |
Prophylaxis - child |
3,236 |
3,196 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
6,937 |
3,976 |
$159K |
| D4342 |
|
5,350 |
2,222 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,962 |
3,315 |
$146K |
| D1206 |
Topical application of fluoride varnish |
4,856 |
4,798 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,770 |
4,470 |
$118K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17,918 |
16,872 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,673 |
2,524 |
$107K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,107 |
1,953 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,482 |
5,717 |
$97K |
| D9110 |
|
3,423 |
1,883 |
$82K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
502 |
502 |
$73K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
9,146 |
8,984 |
$72K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
7,002 |
6,916 |
$72K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
3,687 |
2,950 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
674 |
305 |
$57K |
| D1351 |
Sealant - per tooth |
1,437 |
439 |
$54K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,251 |
2,055 |
$53K |
| 90837 |
Psychotherapy, 53 minutes with patient |
493 |
379 |
$46K |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
494 |
271 |
$38K |
| 99173 |
|
3,028 |
3,019 |
$38K |
| 90834 |
Psychotherapy, 45 minutes with patient |
391 |
309 |
$35K |
| 90674 |
|
1,760 |
1,713 |
$34K |
| 92551 |
|
3,559 |
3,543 |
$33K |
| D0330 |
Panoramic radiographic image |
822 |
492 |
$32K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,544 |
3,489 |
$30K |
| D2331 |
|
835 |
563 |
$26K |
| 90832 |
Psychotherapy, 30 minutes with patient |
711 |
578 |
$26K |
| D2330 |
|
789 |
426 |
$25K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
288 |
286 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,229 |
10,669 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
579 |
383 |
$20K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
69 |
66 |
$20K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
71 |
69 |
$19K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
180 |
179 |
$17K |
| 99188 |
|
621 |
619 |
$16K |
| 99381 |
|
68 |
68 |
$14K |
| D5212 |
|
40 |
39 |
$14K |
| D0272 |
Bitewings - two radiographic images |
521 |
480 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
537 |
379 |
$13K |
| G0151 |
Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
205 |
87 |
$13K |
| H2015 |
Comprehensive community support services, per 15 minutes |
121 |
96 |
$13K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,541 |
2,476 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
92 |
$12K |
| 99401 |
|
804 |
767 |
$11K |
| D2140 |
|
437 |
280 |
$11K |
| 96127 |
|
2,368 |
2,302 |
$11K |
| 90688 |
|
1,415 |
1,393 |
$10K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
771 |
758 |
$10K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
121 |
119 |
$10K |
| 90677 |
|
269 |
266 |
$9K |
| 90661 |
|
601 |
586 |
$9K |
| D2332 |
|
179 |
126 |
$8K |
| 90791 |
Psychiatric diagnostic evaluation |
64 |
64 |
$8K |
| 90715 |
|
271 |
270 |
$8K |
| 87807 |
|
620 |
613 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
568 |
560 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
54 |
54 |
$6K |
| 97802 |
|
52 |
51 |
$5K |
| D5110 |
|
13 |
13 |
$4K |
| 98966 |
|
485 |
450 |
$4K |
| A0425 |
Ground mileage, per statute mile |
261 |
250 |
$4K |
| D4341 |
|
678 |
423 |
$4K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
63 |
60 |
$3K |
| 99495 |
|
174 |
170 |
$3K |
| 81003 |
|
1,439 |
1,391 |
$3K |
| D5211 |
|
12 |
12 |
$3K |
| 90732 |
|
41 |
41 |
$3K |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
81 |
50 |
$2K |
| D2335 |
|
41 |
28 |
$2K |
| 82962 |
|
2,039 |
1,949 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
72 |
71 |
$2K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
80 |
80 |
$2K |
| G0136 |
Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months |
137 |
137 |
$2K |
| 90746 |
|
27 |
27 |
$2K |
| G0300 |
Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes |
18 |
12 |
$2K |
| 99050 |
|
26 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
41 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
42 |
$1K |
| 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 |
27 |
26 |
$1K |
| 81025 |
|
168 |
165 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
102 |
99 |
$1K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
119 |
92 |
$863.52 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
981 |
905 |
$710.12 |
| 93000 |
|
41 |
41 |
$629.35 |
| 92015 |
Determination of refractive state |
48 |
48 |
$616.08 |
| 90670 |
|
170 |
169 |
$577.92 |
| 80305 |
|
78 |
69 |
$515.43 |
| 99000 |
|
1,056 |
855 |
$489.21 |
| 90649 |
|
26 |
26 |
$412.77 |
| 90473 |
|
32 |
32 |
$328.14 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
218 |
209 |
$323.57 |
| 99442 |
|
18 |
14 |
$320.00 |
| D0270 |
|
48 |
41 |
$278.00 |
| 96160 |
|
189 |
189 |
$246.63 |
| 90716 |
|
99 |
98 |
$245.01 |
| 99406 |
|
429 |
417 |
$222.05 |
| 99215 |
Prolong outpt/office vis |
14 |
14 |
$219.27 |
| 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 |
1,026 |
1,018 |
$217.23 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
12 |
12 |
$199.32 |
| D0180 |
|
13 |
13 |
$148.00 |
| 90707 |
|
69 |
69 |
$141.21 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
15 |
15 |
$107.70 |
| 90723 |
|
59 |
58 |
$77.85 |
| 94760 |
|
668 |
638 |
$75.60 |
| 98967 |
|
27 |
27 |
$60.28 |
| D1330 |
|
1,241 |
569 |
$42.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
112 |
104 |
$37.76 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
805 |
800 |
$36.82 |
| 82947 |
|
12 |
12 |
$32.70 |
| 96161 |
|
26 |
25 |
$2.12 |
| G0008 |
Administration of influenza virus vaccine |
826 |
821 |
$0.00 |
| 36416 |
|
456 |
434 |
$0.00 |
| 90651 |
|
86 |
82 |
$0.00 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
106 |
92 |
$0.00 |
| 90697 |
|
57 |
56 |
$0.00 |
| 91301 |
|
872 |
844 |
$0.00 |
| G9226 |
Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
15 |
15 |
$0.00 |
| 90619 |
|
27 |
26 |
$0.00 |
| 90656 |
|
89 |
81 |
$0.00 |
| 90686 |
|
597 |
594 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
20 |
20 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
51 |
51 |
$0.00 |
| 90680 |
|
33 |
33 |
$0.00 |
| 90694 |
|
62 |
61 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
17 |
17 |
$0.00 |
| 91306 |
|
59 |
59 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
66 |
66 |
$0.00 |
| 90633 |
|
240 |
237 |
$0.00 |
| 90653 |
|
47 |
47 |
$0.00 |
| 90648 |
|
161 |
160 |
$0.00 |
| 90687 |
|
40 |
40 |
$0.00 |
| 90461 |
|
164 |
86 |
$0.00 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
28 |
28 |
$0.00 |
| 91300 |
|
92 |
90 |
$0.00 |
| 98960 |
|
14 |
12 |
$0.00 |