| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,068 |
9,513 |
$704K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,144 |
7,476 |
$251K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,744 |
3,156 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
245 |
137 |
$13K |
| D0330 |
Panoramic radiographic image |
183 |
174 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
379 |
368 |
$6K |
| D1120 |
Prophylaxis - child |
343 |
332 |
$6K |
| D1110 |
Prophylaxis - adult |
149 |
142 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
338 |
326 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
134 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
555 |
294 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
50 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
48 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
222 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
116 |
101 |
$3K |
| 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 |
235 |
206 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
30 |
$3K |
| D1351 |
Sealant - per tooth |
134 |
52 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
72 |
44 |
$2K |
| D0274 |
Bitewings - four radiographic images |
138 |
135 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
283 |
175 |
$2K |
| D2331 |
|
23 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
166 |
157 |
$1K |
| 90686 |
|
279 |
154 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
980 |
599 |
$975.66 |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
221 |
$903.00 |
| D2330 |
|
23 |
14 |
$860.32 |
| D2140 |
|
18 |
14 |
$598.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
104 |
58 |
$538.98 |
| 80053 |
Comprehensive metabolic panel |
69 |
41 |
$149.87 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
37 |
35 |
$136.40 |
| 87807 |
|
23 |
12 |
$119.02 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
22 |
12 |
$93.95 |
| 81003 |
|
96 |
53 |
$73.50 |
| 96127 |
|
18 |
12 |
$51.61 |
| 36416 |
|
24 |
12 |
$45.22 |
| 3074F |
|
2,363 |
1,839 |
$0.28 |
| 3078F |
|
1,708 |
1,345 |
$0.16 |
| 3079F |
|
445 |
325 |
$0.12 |
| 4004F |
|
14 |
13 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
49 |
45 |
$0.00 |
| 3008F |
|
1,604 |
1,150 |
$0.00 |
| 1036F |
|
552 |
476 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
614 |
375 |
$0.00 |
| G8433 |
Screening for depression not completed, documented patient or medical reason |
80 |
67 |
$0.00 |
| 3075F |
|
17 |
14 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
24 |
17 |
$0.00 |