| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,710 |
16,976 |
$3.64M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,037 |
3,808 |
$51.58 |
| D0274 |
Bitewings - four radiographic images |
2,357 |
2,105 |
$39.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
476 |
375 |
$14.17 |
| 90686 |
|
158 |
144 |
$7.20 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,129 |
962 |
$1.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
440 |
402 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,428 |
1,284 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
4,339 |
3,797 |
$0.00 |
| 90656 |
|
178 |
157 |
$0.00 |
| 36416 |
|
1,002 |
881 |
$0.00 |
| D0250 |
|
113 |
113 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,233 |
1,000 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,400 |
2,958 |
$0.00 |
| 90636 |
|
48 |
42 |
$0.00 |
| 90723 |
|
13 |
13 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
218 |
170 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,484 |
801 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
718 |
636 |
$0.00 |
| 90680 |
|
97 |
83 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
232 |
225 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,289 |
1,153 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
872 |
720 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
53 |
29 |
$0.00 |
| 90619 |
|
53 |
52 |
$0.00 |
| 90651 |
|
153 |
145 |
$0.00 |
| D1351 |
Sealant - per tooth |
597 |
165 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
610 |
583 |
$0.00 |
| 90647 |
|
104 |
87 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
31 |
$0.00 |
| 1220F |
|
167 |
165 |
$0.00 |
| 1036F |
|
78 |
76 |
$0.00 |
| 90688 |
|
22 |
22 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
916 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
570 |
505 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
189 |
184 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
414 |
328 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,596 |
854 |
$0.00 |
| D0251 |
|
42 |
42 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
57 |
57 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
308 |
222 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
333 |
264 |
$0.00 |
| 90715 |
|
119 |
115 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
278 |
152 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,282 |
1,135 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,003 |
1,702 |
$0.00 |
| 96167 |
|
65 |
55 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,177 |
1,008 |
$0.00 |
| 90670 |
|
196 |
160 |
$0.00 |
| 90633 |
|
95 |
79 |
$0.00 |
| 90734 |
|
67 |
64 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
457 |
434 |
$0.00 |
| 99173 |
|
995 |
900 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
538 |
517 |
$0.00 |
| 83655 |
|
134 |
105 |
$0.00 |
| 90671 |
|
29 |
29 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
161 |
112 |
$0.00 |
| 81002 |
|
84 |
70 |
$0.00 |
| 96152 |
|
312 |
88 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 90700 |
|
20 |
12 |
$0.00 |
| 96158 |
|
126 |
88 |
$0.00 |
| 99177 |
|
12 |
12 |
$0.00 |
| D0190 |
|
13 |
13 |
$0.00 |
| 1159F |
|
104 |
102 |
$0.00 |
| 90621 |
|
39 |
39 |
$0.00 |
| 90685 |
|
25 |
18 |
$0.00 |