| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,633 |
9,077 |
$1.80M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,368 |
22,576 |
$529K |
| D0120 |
Periodic oral evaluation - established patient |
8,801 |
8,650 |
$199K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,953 |
2,221 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,828 |
2,803 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,614 |
3,507 |
$113K |
| D1206 |
Topical application of fluoride varnish |
9,286 |
9,018 |
$103K |
| D1110 |
Prophylaxis - adult |
3,170 |
3,118 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
3,250 |
3,009 |
$93K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,584 |
3,233 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
2,285 |
2,239 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
13,470 |
12,894 |
$74K |
| D1351 |
Sealant - per tooth |
5,546 |
1,669 |
$72K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,953 |
1,768 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,398 |
628 |
$67K |
| D0274 |
Bitewings - four radiographic images |
6,607 |
6,485 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,517 |
1,074 |
$59K |
| 90791 |
Psychiatric diagnostic evaluation |
624 |
602 |
$51K |
| 90834 |
Psychotherapy, 45 minutes with patient |
720 |
529 |
$49K |
| 0012A |
|
911 |
881 |
$40K |
| 0011A |
|
965 |
884 |
$40K |
| 90686 |
|
1,826 |
1,805 |
$35K |
| D1120 |
Prophylaxis - child |
1,551 |
1,535 |
$33K |
| 0001A |
|
626 |
624 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,152 |
8,653 |
$29K |
| 0002A |
|
533 |
532 |
$28K |
| D4910 |
|
481 |
475 |
$23K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
942 |
824 |
$15K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
552 |
534 |
$13K |
| D0330 |
Panoramic radiographic image |
1,014 |
985 |
$13K |
| 0031A |
|
312 |
278 |
$12K |
| D1354 |
|
2,554 |
528 |
$11K |
| 97810 |
|
421 |
311 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
99 |
96 |
$10K |
| 99442 |
|
900 |
810 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
81 |
80 |
$8K |
| 90837 |
Psychotherapy, 53 minutes with patient |
63 |
48 |
$7K |
| 97811 |
|
307 |
227 |
$6K |
| D1355 |
|
258 |
109 |
$5K |
| 80305 |
|
724 |
511 |
$5K |
| 99443 |
|
345 |
307 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
52 |
$5K |
| 0064A |
|
67 |
66 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,342 |
1,314 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
274 |
243 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
149 |
112 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
388 |
376 |
$3K |
| 87428 |
|
159 |
156 |
$3K |
| D4342 |
|
41 |
24 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
40 |
38 |
$2K |
| D0272 |
Bitewings - two radiographic images |
249 |
246 |
$2K |
| D0270 |
|
264 |
247 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
20 |
12 |
$1K |
| D9990 |
|
26 |
25 |
$1K |
| 96160 |
|
604 |
583 |
$1K |
| 99402 |
|
28 |
25 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$1K |
| D0180 |
|
59 |
55 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
596 |
511 |
$957.16 |
| D2940 |
|
21 |
14 |
$882.72 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
41 |
39 |
$851.24 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
85 |
82 |
$811.42 |
| 99173 |
|
238 |
234 |
$564.53 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
41 |
40 |
$368.85 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$351.00 |
| 99441 |
|
83 |
79 |
$341.30 |
| 81025 |
|
61 |
53 |
$335.79 |
| 90685 |
|
13 |
13 |
$285.48 |
| D1320 |
|
15 |
14 |
$130.00 |
| 81003 |
|
32 |
29 |
$34.00 |
| 91306 |
|
66 |
65 |
$0.52 |
| D0602 |
|
1,573 |
1,558 |
$0.00 |
| D0603 |
|
3,896 |
3,773 |
$0.00 |
| 99000 |
|
311 |
294 |
$0.00 |
| 91303 |
|
41 |
24 |
$0.00 |
| D0601 |
|
57 |
57 |
$0.00 |
| D9995 |
|
91 |
82 |
$0.00 |
| 91301 |
|
357 |
262 |
$0.00 |