| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,733 |
5,923 |
$1.53M |
| D0999 |
Unspecified diagnostic procedure, by report |
2,459 |
2,116 |
$712K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
955 |
913 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
844 |
795 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,675 |
3,306 |
$5K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
99 |
96 |
$1K |
| 90686 |
|
409 |
384 |
$592.88 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
66 |
$440.00 |
| 36415 |
Collection of venous blood by venipuncture |
107 |
103 |
$122.19 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
57 |
56 |
$42.61 |
| 3074F |
|
1,708 |
1,601 |
$39.32 |
| 3079F |
|
384 |
358 |
$39.32 |
| D1110 |
Prophylaxis - adult |
585 |
582 |
$0.00 |
| 3078F |
|
1,375 |
1,299 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
841 |
774 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
327 |
$0.00 |
| D1120 |
Prophylaxis - child |
426 |
424 |
$0.00 |
| 1159F |
|
1,547 |
1,405 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
284 |
284 |
$0.00 |
| D0330 |
Panoramic radiographic image |
221 |
221 |
$0.00 |
| 4004F |
|
70 |
65 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
13 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
35 |
35 |
$0.00 |
| 90734 |
|
15 |
15 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$0.00 |
| 2001F |
|
2,514 |
2,325 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
204 |
$0.00 |
| 1111F |
|
345 |
323 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
516 |
516 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
865 |
798 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
67 |
67 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
163 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
137 |
137 |
$0.00 |
| 3075F |
|
28 |
26 |
$0.00 |
| 90656 |
|
19 |
19 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
772 |
765 |
$0.00 |
| 90651 |
|
31 |
31 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
137 |
137 |
$0.00 |
| D1352 |
|
28 |
13 |
$0.00 |