| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
32,088 |
23,780 |
$1.74M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,503 |
6,002 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,608 |
1,440 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,244 |
1,799 |
$108K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,166 |
3,572 |
$68K |
| D1120 |
Prophylaxis - child |
6,633 |
5,302 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,539 |
5,997 |
$45K |
| D1351 |
Sealant - per tooth |
3,659 |
1,336 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
4,491 |
3,543 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
558 |
365 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
647 |
486 |
$29K |
| D0330 |
Panoramic radiographic image |
1,492 |
1,221 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,729 |
3,011 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,325 |
2,954 |
$24K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,328 |
704 |
$20K |
| D1110 |
Prophylaxis - adult |
1,180 |
914 |
$20K |
| D0272 |
Bitewings - two radiographic images |
5,095 |
4,066 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
290 |
182 |
$17K |
| 92015 |
Determination of refractive state |
5,992 |
4,142 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
295 |
182 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,377 |
1,134 |
$10K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
125 |
116 |
$10K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
266 |
129 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
29 |
$8K |
| 87428 |
|
447 |
242 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
1,073 |
879 |
$7K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
217 |
117 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
470 |
347 |
$6K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
645 |
354 |
$4K |
| D1354 |
|
198 |
75 |
$4K |
| 92341 |
|
697 |
505 |
$4K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
164 |
97 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,640 |
1,292 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
97 |
43 |
$3K |
| D2330 |
|
23 |
15 |
$2K |
| 90686 |
|
319 |
212 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
262 |
73 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
55 |
30 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
58 |
33 |
$2K |
| V2020 |
Frames, purchases |
205 |
171 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
116 |
72 |
$1K |
| 90734 |
|
193 |
113 |
$718.70 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
73 |
42 |
$632.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
21 |
12 |
$629.31 |
| 90619 |
|
49 |
31 |
$471.60 |
| 96127 |
|
212 |
117 |
$409.77 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
29 |
$360.00 |
| 36415 |
Collection of venous blood by venipuncture |
308 |
181 |
$346.07 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
21 |
21 |
$260.00 |
| 81002 |
|
72 |
42 |
$93.09 |
| 90715 |
|
116 |
68 |
$91.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
67 |
$90.00 |
| V2799 |
Vision item or service, miscellaneous |
293 |
63 |
$0.16 |
| 3049F |
|
246 |
122 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
4,588 |
3,888 |
$0.00 |
| H0049 |
Alcohol and/or drug screening |
1,791 |
1,000 |
$0.00 |
| 3079F |
|
823 |
447 |
$0.00 |
| 3075F |
|
73 |
30 |
$0.00 |
| 1126F |
|
471 |
294 |
$0.00 |
| 1036F |
|
6,073 |
3,543 |
$0.00 |
| 3048F |
|
986 |
484 |
$0.00 |
| 4010F |
|
171 |
84 |
$0.00 |
| 3008F |
|
3,377 |
1,841 |
$0.00 |
| 3074F |
|
2,928 |
1,575 |
$0.00 |
| 1125F |
|
259 |
128 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
52 |
29 |
$0.00 |
| 3017F |
|
109 |
53 |
$0.00 |
| 3061F |
|
37 |
14 |
$0.00 |
| 1159F |
|
3,268 |
1,752 |
$0.00 |
| 4004F |
|
3,629 |
1,927 |
$0.00 |
| G8506 |
Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy |
502 |
270 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
4,800 |
4,401 |
$0.00 |
| 1160F |
|
3,268 |
1,752 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
2,062 |
1,110 |
$0.00 |
| 3078F |
|
2,313 |
1,254 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
510 |
285 |
$0.00 |
| 3015F |
|
158 |
68 |
$0.00 |
| 3050F |
|
150 |
78 |
$0.00 |
| D0270 |
|
56 |
48 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
48 |
26 |
$0.00 |