| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
28,468 |
22,282 |
$5.69M |
| D9999 |
Unspecified adjunctive procedure, by report |
24,912 |
20,253 |
$3.84M |
| D0999 |
Unspecified diagnostic procedure, by report |
6,468 |
5,417 |
$1.46M |
| D0120 |
Periodic oral evaluation - established patient |
9,778 |
9,603 |
$43K |
| D1120 |
Prophylaxis - child |
5,067 |
4,962 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,110 |
6,990 |
$28K |
| D1110 |
Prophylaxis - adult |
5,242 |
5,163 |
$28K |
| D0274 |
Bitewings - four radiographic images |
6,269 |
6,158 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,101 |
1,534 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,883 |
1,390 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,105 |
12,205 |
$9K |
| D0330 |
Panoramic radiographic image |
2,651 |
2,612 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,019 |
2,982 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
885 |
877 |
$7K |
| D1351 |
Sealant - per tooth |
2,076 |
499 |
$6K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,888 |
1,755 |
$5K |
| D1999 |
|
16 |
16 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,022 |
3,522 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
1,813 |
1,780 |
$2K |
| 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 |
30 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
198 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
208 |
162 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
976 |
913 |
$1K |
| D2140 |
|
92 |
65 |
$1K |
| 90686 |
|
289 |
280 |
$942.50 |
| D1206 |
Topical application of fluoride varnish |
73 |
69 |
$415.03 |
| D0220 |
Intraoral - periapical first radiographic image |
1,026 |
1,005 |
$291.16 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
20 |
15 |
$196.36 |
| 90656 |
|
140 |
138 |
$182.74 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
201 |
192 |
$180.14 |
| 80061 |
Lipid panel |
1,121 |
1,058 |
$157.71 |
| D2331 |
|
138 |
104 |
$144.41 |
| D0272 |
Bitewings - two radiographic images |
72 |
72 |
$143.20 |
| 90832 |
Psychotherapy, 30 minutes with patient |
92 |
62 |
$122.79 |
| D2330 |
|
90 |
60 |
$115.02 |
| D1353 |
|
28 |
12 |
$90.14 |
| 90837 |
Psychotherapy, 53 minutes with patient |
40 |
34 |
$77.84 |
| 36415 |
Collection of venous blood by venipuncture |
2,220 |
2,053 |
$60.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
216 |
213 |
$54.63 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,112 |
1,044 |
$52.65 |
| 87428 |
|
324 |
299 |
$40.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
122 |
111 |
$39.90 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
536 |
510 |
$22.55 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
13 |
$12.66 |
| 82044 |
|
30 |
28 |
$6.51 |
| 81003 |
|
124 |
106 |
$3.18 |
| 36416 |
|
76 |
70 |
$3.17 |
| D4910 |
|
335 |
332 |
$2.56 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
24 |
$0.14 |
| D4341 |
|
16 |
12 |
$0.04 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$0.00 |
| 90651 |
|
46 |
45 |
$0.00 |
| 86803 |
|
15 |
12 |
$0.00 |
| 92587 |
|
13 |
12 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
14 |
14 |
$0.00 |
| 87400 |
|
137 |
134 |
$0.00 |
| 90461 |
|
14 |
14 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
139 |
138 |
$0.00 |
| 81025 |
|
13 |
12 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
16 |
$0.00 |
| 90633 |
|
14 |
14 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
13 |
12 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21 |
21 |
$0.00 |