| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,848 |
17,300 |
$3.16M |
| D0999 |
Unspecified diagnostic procedure, by report |
13,165 |
8,757 |
$1.35M |
| H2020 |
Therapeutic behavioral services, per diem |
1,997 |
1,385 |
$243K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,319 |
2,660 |
$23K |
| D1110 |
Prophylaxis - adult |
3,779 |
2,759 |
$10K |
| D0330 |
Panoramic radiographic image |
2,942 |
2,097 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,087 |
2,292 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
2,352 |
1,797 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
819 |
605 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
212 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,417 |
983 |
$947.92 |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
69 |
$592.08 |
| 3074F |
|
6,399 |
5,095 |
$395.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
44 |
$318.78 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19,543 |
14,565 |
$308.34 |
| 3079F |
|
3,841 |
3,090 |
$290.00 |
| D0220 |
Intraoral - periapical first radiographic image |
228 |
168 |
$264.66 |
| 3078F |
|
5,770 |
4,596 |
$260.00 |
| 3077F |
|
2,195 |
1,717 |
$165.00 |
| 1126F |
|
4,021 |
3,192 |
$152.13 |
| 3080F |
|
694 |
539 |
$105.00 |
| 3075F |
|
1,750 |
1,466 |
$95.00 |
| 0513F |
|
34 |
27 |
$40.00 |
| D0272 |
Bitewings - two radiographic images |
354 |
338 |
$21.43 |
| 82947 |
|
2,940 |
2,248 |
$0.00 |
| 81003 |
|
2,980 |
2,414 |
$0.00 |
| 96160 |
|
10,948 |
8,463 |
$0.00 |
| 80305 |
|
4,539 |
3,543 |
$0.00 |
| D1120 |
Prophylaxis - child |
616 |
566 |
$0.00 |
| 1159F |
|
1,671 |
1,360 |
$0.00 |
| 1160F |
|
7,977 |
6,146 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
735 |
591 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,195 |
974 |
$0.00 |
| 81025 |
|
597 |
508 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
1,293 |
1,041 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
527 |
446 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
523 |
419 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
563 |
411 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
87 |
43 |
$0.00 |
| 99173 |
|
39 |
36 |
$0.00 |
| G8476 |
Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
13 |
12 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$0.00 |
| 91300 |
|
31 |
15 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
49 |
45 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
29 |
$0.00 |
| D1999 |
|
41 |
39 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
12 |
$0.00 |
| G8404 |
Lower extremity neurological exam performed and documented |
15 |
14 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
74 |
27 |
$0.00 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
16 |
15 |
$0.00 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
13 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
116 |
105 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
19 |
$0.00 |
| D2140 |
|
20 |
13 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
13 |
$0.00 |
| 90756 |
|
88 |
71 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
25 |
12 |
$0.00 |
| 1111F |
|
1,705 |
1,189 |
$0.00 |
| 97802 |
|
3,618 |
2,663 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
78 |
66 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,755 |
1,341 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
2,055 |
1,578 |
$0.00 |
| 1125F |
|
1,352 |
1,101 |
$0.00 |
| J1030 |
Injection, methylprednisolone acetate, 40 mg |
15 |
12 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,505 |
1,104 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,440 |
1,145 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
74 |
66 |
$0.00 |
| J2360 |
Injection, orphenadrine citrate, up to 60 mg |
141 |
108 |
$0.00 |
| 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 |
295 |
238 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
960 |
867 |
$0.00 |
| 00000 |
|
313 |
262 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
972 |
804 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
155 |
124 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
1,045 |
831 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
164 |
127 |
$0.00 |
| 82043 |
|
451 |
385 |
$0.00 |
| 99406 |
|
144 |
128 |
$0.00 |
| 3061F |
|
31 |
29 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
19 |
16 |
$0.00 |
| 85018 |
|
97 |
78 |
$0.00 |
| 90619 |
|
15 |
15 |
$0.00 |
| 94760 |
|
18 |
12 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
31 |
29 |
$0.00 |
| 90686 |
|
42 |
36 |
$0.00 |
| 90651 |
|
15 |
15 |
$0.00 |
| 3044F |
|
20 |
18 |
$0.00 |