| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,978 |
3,566 |
$406K |
| D9450 |
|
4,091 |
1,960 |
$92K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
472 |
428 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
653 |
275 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
953 |
510 |
$9K |
| 99381 |
|
34 |
34 |
$7K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
73 |
73 |
$6K |
| 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 |
163 |
149 |
$6K |
| D1110 |
Prophylaxis - adult |
1,038 |
667 |
$6K |
| D1120 |
Prophylaxis - child |
100 |
96 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
753 |
431 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
65 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
333 |
163 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
302 |
302 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
576 |
253 |
$4K |
| D1206 |
Topical application of fluoride varnish |
139 |
134 |
$4K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
93 |
93 |
$3K |
| D4341 |
|
187 |
90 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
288 |
179 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
174 |
173 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
636 |
632 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
67 |
67 |
$2K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
14 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
466 |
326 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
192 |
168 |
$2K |
| D0180 |
|
545 |
354 |
$2K |
| D0274 |
Bitewings - four radiographic images |
188 |
131 |
$2K |
| 92015 |
Determination of refractive state |
130 |
129 |
$1K |
| 81025 |
|
168 |
167 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
45 |
44 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
34 |
34 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
17 |
$900.54 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
380 |
379 |
$883.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
43 |
43 |
$627.80 |
| 90686 |
|
79 |
79 |
$304.48 |
| 93000 |
|
13 |
13 |
$199.55 |
| 90707 |
|
43 |
43 |
$188.28 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$174.96 |
| 90474 |
|
60 |
60 |
$105.96 |
| D0270 |
|
14 |
14 |
$28.00 |
| 81003 |
|
12 |
12 |
$21.78 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
71 |
68 |
$0.00 |
| 90677 |
|
193 |
193 |
$0.00 |
| 90697 |
|
86 |
86 |
$0.00 |
| 90680 |
|
62 |
62 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$0.00 |
| 90716 |
|
39 |
39 |
$0.00 |
| 90633 |
|
119 |
119 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
24 |
24 |
$0.00 |
| 90700 |
|
26 |
26 |
$0.00 |
| 90661 |
|
81 |
81 |
$0.00 |