| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,199 |
1,169 |
$45K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
777 |
703 |
$23K |
| T1017 |
Targeted case management, each 15 minutes |
364 |
127 |
$13K |
| D1330 |
|
416 |
405 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,692 |
1,539 |
$10K |
| D1110 |
Prophylaxis - adult |
515 |
498 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
625 |
520 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
162 |
151 |
$7K |
| 99442 |
|
457 |
416 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
160 |
$3K |
| T1015 |
Clinic visit/encounter, all-inclusive |
55 |
52 |
$3K |
| 99385 |
|
43 |
36 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
42 |
$2K |
| D4355 |
|
52 |
52 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
37 |
$1K |
| 99441 |
|
225 |
208 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
67 |
59 |
$1K |
| 99401 |
|
123 |
118 |
$1K |
| D1351 |
Sealant - per tooth |
63 |
30 |
$1K |
| D1120 |
Prophylaxis - child |
169 |
165 |
$952.08 |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
45 |
19 |
$944.72 |
| 36415 |
Collection of venous blood by venipuncture |
535 |
438 |
$446.61 |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$365.02 |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
478 |
$349.92 |
| D1208 |
Topical application of fluoride, excluding varnish |
185 |
179 |
$316.61 |
| 99408 |
|
43 |
38 |
$275.84 |
| 80061 |
Lipid panel |
54 |
46 |
$232.18 |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
17 |
14 |
$216.67 |
| 80053 |
Comprehensive metabolic panel |
90 |
71 |
$164.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
90 |
72 |
$162.00 |
| 3074F |
|
1,080 |
929 |
$150.08 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$135.67 |
| 3078F |
|
877 |
721 |
$112.94 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$101.52 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
59 |
39 |
$75.00 |
| 81001 |
|
52 |
51 |
$50.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
35 |
28 |
$48.00 |
| 86703 |
|
16 |
13 |
$23.28 |
| 1126F |
|
888 |
814 |
$0.11 |
| 2001F |
|
2,766 |
2,323 |
$0.04 |
| 1220F |
|
2,015 |
1,752 |
$0.04 |
| 1036F |
|
323 |
304 |
$0.00 |
| 3008F |
|
2,674 |
2,240 |
$0.00 |
| 2000F |
|
1,068 |
888 |
$0.00 |
| 1000F |
|
1,834 |
1,621 |
$0.00 |
| 3351F |
|
742 |
671 |
$0.00 |
| 1125F |
|
80 |
73 |
$0.00 |
| 3044F |
|
55 |
50 |
$0.00 |
| 3079F |
|
75 |
63 |
$0.00 |
| 1157F |
|
50 |
33 |
$0.00 |
| 4000F |
|
52 |
46 |
$0.00 |
| 1034F |
|
29 |
27 |
$0.00 |
| 1160F |
|
337 |
281 |
$0.00 |
| 1159F |
|
337 |
282 |
$0.00 |
| 3725F |
|
387 |
352 |
$0.00 |