| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,462 |
14,285 |
$3.56M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
393 |
326 |
$55K |
| D9450 |
|
4,460 |
2,221 |
$47K |
| 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 |
864 |
688 |
$32K |
| D1110 |
Prophylaxis - adult |
852 |
526 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
687 |
418 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
329 |
184 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
75 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
542 |
276 |
$10K |
| 90746 |
|
182 |
179 |
$9K |
| 90658 |
|
648 |
643 |
$7K |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
52 |
16 |
$5K |
| 90632 |
|
116 |
115 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,706 |
1,602 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
271 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
261 |
186 |
$4K |
| 82948 |
|
887 |
680 |
$3K |
| D0274 |
Bitewings - four radiographic images |
78 |
46 |
$1K |
| D9110 |
|
65 |
32 |
$1K |
| 80305 |
|
149 |
117 |
$1K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
22 |
20 |
$910.36 |
| 86580 |
|
131 |
130 |
$774.94 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
12 |
$714.00 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
13 |
13 |
$618.15 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
21 |
19 |
$513.47 |
| 90715 |
|
14 |
14 |
$414.05 |
| 99000 |
|
3,893 |
3,530 |
$152.73 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
14 |
14 |
$100.52 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
433 |
390 |
$54.29 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
91 |
88 |
$52.98 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
287 |
242 |
$52.78 |
| 99050 |
|
27 |
25 |
$52.38 |
| 36415 |
Collection of venous blood by venipuncture |
2,928 |
2,826 |
$39.39 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
17 |
13 |
$4.80 |
| 90732 |
|
12 |
12 |
$0.10 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
512 |
471 |
$0.00 |
| D0603 |
|
28 |
15 |
$0.00 |
| D1330 |
|
93 |
49 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
96 |
92 |
$0.00 |
| 90734 |
|
20 |
20 |
$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) |
21 |
21 |
$0.00 |