| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,683 |
13,743 |
$1.26M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,644 |
5,998 |
$173K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,425 |
2,203 |
$100K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,299 |
2,881 |
$56K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,115 |
507 |
$23K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
729 |
542 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
768 |
480 |
$7K |
| D0330 |
Panoramic radiographic image |
415 |
271 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
533 |
347 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
221 |
115 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
133 |
91 |
$4K |
| D1110 |
Prophylaxis - adult |
305 |
194 |
$4K |
| 81025 |
|
746 |
566 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
85 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
84 |
41 |
$2K |
| D0274 |
Bitewings - four radiographic images |
448 |
290 |
$2K |
| 81002 |
|
1,748 |
1,320 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
125 |
62 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
637 |
408 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
50 |
24 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
106 |
51 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
212 |
133 |
$608.94 |
| 87210 |
|
235 |
126 |
$522.41 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
20 |
13 |
$506.61 |
| D1120 |
Prophylaxis - child |
65 |
48 |
$500.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
77 |
55 |
$480.00 |
| 86580 |
|
138 |
108 |
$471.56 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
60 |
37 |
$377.00 |
| D0120 |
Periodic oral evaluation - established patient |
97 |
61 |
$358.68 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
42 |
25 |
$291.13 |
| 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 |
44 |
25 |
$268.90 |
| 82948 |
|
135 |
73 |
$180.74 |
| D0272 |
Bitewings - two radiographic images |
39 |
29 |
$150.00 |
| 3074F |
|
249 |
157 |
$0.34 |
| 3078F |
|
160 |
91 |
$0.22 |
| 90688 |
|
15 |
13 |
$0.06 |
| 3077F |
|
47 |
28 |
$0.03 |
| 3075F |
|
21 |
14 |
$0.02 |
| 90734 |
|
14 |
14 |
$0.00 |
| 90461 |
|
27 |
26 |
$0.00 |
| 3080F |
|
33 |
16 |
$0.00 |
| 1036F |
|
28 |
19 |
$0.00 |