| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
170,366 |
116,702 |
$20.96M |
| D0999 |
Unspecified diagnostic procedure, by report |
36,548 |
29,978 |
$3.90M |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
1,302 |
930 |
$86K |
| D1120 |
Prophylaxis - child |
5,651 |
5,571 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,761 |
4,218 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
4,652 |
4,472 |
$14K |
| D0330 |
Panoramic radiographic image |
5,520 |
5,375 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
5,391 |
5,296 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,093 |
2,433 |
$10K |
| D1110 |
Prophylaxis - adult |
2,538 |
2,470 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,269 |
2,612 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
4,430 |
4,181 |
$7K |
| D4341 |
|
697 |
354 |
$6K |
| 0012A |
|
125 |
125 |
$5K |
| 0011A |
|
149 |
139 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,300 |
4,163 |
$5K |
| 99000 |
|
188 |
140 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
974 |
737 |
$2K |
| D0274 |
Bitewings - four radiographic images |
6,003 |
5,893 |
$966.31 |
| D2331 |
|
387 |
308 |
$921.90 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
745 |
651 |
$883.20 |
| D9110 |
|
302 |
296 |
$880.00 |
| D2330 |
|
375 |
308 |
$785.50 |
| D1206 |
Topical application of fluoride varnish |
4,651 |
4,621 |
$780.00 |
| D0272 |
Bitewings - two radiographic images |
1,421 |
1,380 |
$443.60 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
99,271 |
67,667 |
$344.17 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,092 |
13,434 |
$312.37 |
| D2335 |
|
14 |
12 |
$220.80 |
| D2332 |
|
73 |
64 |
$220.80 |
| 90686 |
|
659 |
392 |
$127.15 |
| 90688 |
|
274 |
235 |
$95.88 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,834 |
1,634 |
$76.84 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
735 |
660 |
$62.50 |
| 90723 |
|
65 |
50 |
$12.80 |
| 90648 |
|
127 |
102 |
$12.80 |
| 90670 |
|
130 |
105 |
$12.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
502 |
499 |
$3.80 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,746 |
1,542 |
$0.00 |
| 96127 |
|
2,298 |
1,763 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
3,885 |
3,605 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,414 |
1,238 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
208 |
179 |
$0.00 |
| 87807 |
|
555 |
528 |
$0.00 |
| 99383 |
|
37 |
37 |
$0.00 |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
561 |
356 |
$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 |
289 |
271 |
$0.00 |
| D1351 |
Sealant - per tooth |
547 |
248 |
$0.00 |
| D0603 |
|
626 |
621 |
$0.00 |
| 99441 |
|
63 |
58 |
$0.00 |
| 99384 |
|
12 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
826 |
568 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
137 |
136 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
91 |
87 |
$0.00 |
| 86580 |
|
26 |
26 |
$0.00 |
| D0602 |
|
115 |
115 |
$0.00 |
| 99443 |
|
44 |
42 |
$0.00 |
| 90651 |
|
15 |
13 |
$0.00 |
| 82962 |
|
15 |
15 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,225 |
2,821 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,624 |
1,433 |
$0.00 |
| 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 |
1,326 |
1,326 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
268 |
265 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,822 |
2,491 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,153 |
1,876 |
$0.00 |
| 90461 |
|
2,074 |
1,817 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,030 |
6,710 |
$0.00 |
| 90473 |
|
27 |
27 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
638 |
596 |
$0.00 |
| 81002 |
|
1,028 |
978 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
236 |
196 |
$0.00 |
| 0502F |
|
880 |
452 |
$0.00 |
| 81025 |
|
620 |
587 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,354 |
1,276 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
544 |
412 |
$0.00 |
| 99307 |
|
333 |
217 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
103 |
68 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,119 |
1,078 |
$0.00 |
| 99442 |
|
143 |
119 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
65 |
56 |
$0.00 |
| 90715 |
|
38 |
30 |
$0.00 |
| D2394 |
|
16 |
13 |
$0.00 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
52 |
34 |
$0.00 |
| 90734 |
|
22 |
19 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
38 |
35 |
$0.00 |
| 90685 |
|
22 |
15 |
$0.00 |
| 90681 |
|
16 |
15 |
$0.00 |
| 99382 |
|
16 |
16 |
$0.00 |
| 90633 |
|
15 |
15 |
$0.00 |