| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,132 |
13,102 |
$2.97M |
| D1110 |
Prophylaxis - adult |
3,620 |
3,489 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,051 |
791 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,969 |
3,868 |
$111K |
| D1120 |
Prophylaxis - child |
1,976 |
1,914 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,877 |
2,771 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,552 |
1,501 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
594 |
407 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
696 |
630 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
486 |
439 |
$17K |
| D0330 |
Panoramic radiographic image |
297 |
277 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
426 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
131 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,603 |
5,051 |
$7K |
| D1351 |
Sealant - per tooth |
151 |
27 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
549 |
494 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,008 |
2,695 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
876 |
754 |
$2K |
| D0272 |
Bitewings - two radiographic images |
58 |
56 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,094 |
481 |
$555.63 |
| 99442 |
|
412 |
348 |
$314.62 |
| D1330 |
|
69 |
66 |
$252.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
2,645 |
1,209 |
$219.85 |
| 90686 |
|
293 |
288 |
$57.15 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
1,808 |
1,606 |
$53.44 |
| 90688 |
|
46 |
38 |
$51.90 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
40 |
38 |
$0.00 |
| 90661 |
|
13 |
13 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
226 |
150 |
$0.00 |
| 90836 |
|
28 |
28 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
33 |
33 |
$0.00 |
| 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 |
26 |
25 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
23 |
15 |
$0.00 |