| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
58,509 |
40,242 |
$3.26M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,633 |
7,674 |
$374K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18,998 |
11,905 |
$300K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
20,306 |
12,199 |
$135K |
| 92015 |
Determination of refractive state |
22,898 |
14,274 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,161 |
1,276 |
$92K |
| D1351 |
Sealant - per tooth |
18,752 |
3,645 |
$89K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,790 |
1,029 |
$56K |
| D1120 |
Prophylaxis - child |
9,844 |
7,375 |
$43K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
962 |
537 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
7,996 |
6,110 |
$31K |
| D1206 |
Topical application of fluoride varnish |
6,628 |
4,868 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,975 |
1,641 |
$25K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,904 |
1,116 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
969 |
545 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,794 |
1,928 |
$16K |
| D1354 |
|
5,907 |
1,481 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
444 |
245 |
$13K |
| D0330 |
Panoramic radiographic image |
912 |
626 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,309 |
4,155 |
$12K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,644 |
882 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
6,777 |
4,972 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,180 |
4,006 |
$9K |
| V2020 |
Frames, purchases |
878 |
597 |
$9K |
| D0272 |
Bitewings - two radiographic images |
4,510 |
3,445 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
282 |
271 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
438 |
211 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
814 |
536 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,841 |
1,411 |
$4K |
| 99381 |
|
238 |
169 |
$4K |
| 90660 |
|
401 |
234 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
395 |
$2K |
| 90473 |
|
315 |
188 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
322 |
172 |
$2K |
| 90651 |
|
58 |
39 |
$2K |
| 96160 |
|
991 |
543 |
$2K |
| D1110 |
Prophylaxis - adult |
323 |
259 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
250 |
108 |
$1K |
| 94010 |
|
114 |
60 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
79 |
48 |
$1K |
| 90686 |
|
169 |
93 |
$389.03 |
| 90688 |
|
111 |
58 |
$232.08 |
| 90658 |
|
313 |
164 |
$231.96 |
| D2140 |
|
165 |
117 |
$0.00 |
| 3078F |
|
2,763 |
1,655 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
29 |
$0.00 |
| 90734 |
|
18 |
12 |
$0.00 |
| 3008F |
|
2,719 |
1,231 |
$0.00 |
| 3074F |
|
2,114 |
1,667 |
$0.00 |
| 90744 |
|
23 |
16 |
$0.00 |
| 3079F |
|
38 |
27 |
$0.00 |
| D0603 |
|
428 |
382 |
$0.00 |