| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
56,255 |
52,598 |
$13.29M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
21,457 |
20,438 |
$97K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,175 |
5,992 |
$89K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,144 |
1,142 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
76 |
67 |
$23K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,885 |
1,850 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
796 |
795 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
101 |
$14K |
| 90834 |
Psychotherapy, 45 minutes with patient |
153 |
127 |
$12K |
| V2020 |
Frames, purchases |
1,167 |
1,165 |
$12K |
| 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 |
376 |
334 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,123 |
3,105 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
96 |
$7K |
| 90832 |
Psychotherapy, 30 minutes with patient |
80 |
68 |
$4K |
| 0002A |
|
90 |
89 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
271 |
271 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
185 |
185 |
$3K |
| 0072A |
|
59 |
59 |
$2K |
| 0071A |
|
56 |
56 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,101 |
2,099 |
$2K |
| 90656 |
|
152 |
152 |
$2K |
| 97802 |
|
78 |
78 |
$2K |
| 0001A |
|
46 |
46 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
393 |
393 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
123 |
123 |
$885.78 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
39 |
39 |
$875.60 |
| D1120 |
Prophylaxis - child |
1,547 |
1,547 |
$853.72 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
386 |
386 |
$684.98 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
54 |
54 |
$666.79 |
| D1206 |
Topical application of fluoride varnish |
2,138 |
2,136 |
$621.86 |
| D0120 |
Periodic oral evaluation - established patient |
1,711 |
1,711 |
$608.33 |
| 90651 |
|
13 |
13 |
$501.90 |
| D1110 |
Prophylaxis - adult |
533 |
533 |
$463.32 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$444.74 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$411.60 |
| 90686 |
|
1,607 |
1,607 |
$397.67 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
97 |
94 |
$364.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$334.80 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$292.95 |
| D0330 |
Panoramic radiographic image |
119 |
119 |
$196.03 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$194.38 |
| D0274 |
Bitewings - four radiographic images |
506 |
506 |
$187.26 |
| 90715 |
|
83 |
83 |
$77.34 |
| 90746 |
|
53 |
53 |
$65.89 |
| D1354 |
|
95 |
42 |
$34.17 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
234 |
$30.50 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
111 |
111 |
$15.55 |
| 3079F |
|
761 |
743 |
$0.00 |
| 1111F |
|
2,689 |
2,531 |
$0.00 |
| 3008F |
|
2,423 |
2,332 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
574 |
574 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,181 |
1,179 |
$0.00 |
| 3074F |
|
1,849 |
1,796 |
$0.00 |
| 4010F |
|
57 |
57 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
79 |
79 |
$0.00 |
| 3075F |
|
79 |
79 |
$0.00 |
| 3080F |
|
13 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
85 |
27 |
$0.00 |
| 3044F |
|
12 |
12 |
$0.00 |
| 99386 |
|
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
1,428 |
1,428 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
632 |
632 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
516 |
516 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,464 |
1,464 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
596 |
592 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
35 |
35 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
424 |
423 |
$0.00 |
| 3078F |
|
1,209 |
1,181 |
$0.00 |
| 3077F |
|
27 |
27 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
26 |
$0.00 |
| 97803 |
|
12 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
29 |
29 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$0.00 |
| 90661 |
|
48 |
48 |
$0.00 |