| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,709 |
5,000 |
$167K |
| T1015 |
Clinic visit/encounter, all-inclusive |
773 |
638 |
$113K |
| D1110 |
Prophylaxis - adult |
2,894 |
2,876 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,427 |
2,405 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
906 |
863 |
$30K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,060 |
1,000 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
809 |
585 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,210 |
1,203 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,278 |
1,202 |
$16K |
| D1120 |
Prophylaxis - child |
1,086 |
1,074 |
$14K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
301 |
297 |
$13K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
268 |
263 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
654 |
643 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,031 |
1,022 |
$10K |
| 59426 |
|
159 |
108 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
207 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
402 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
136 |
134 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
168 |
164 |
$6K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
128 |
128 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
351 |
342 |
$4K |
| 59425 |
|
88 |
76 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
620 |
617 |
$3K |
| D0274 |
Bitewings - four radiographic images |
359 |
356 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
609 |
593 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
154 |
145 |
$2K |
| D2335 |
|
33 |
24 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
221 |
214 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
44 |
44 |
$2K |
| 90686 |
|
131 |
131 |
$1K |
| V5008 |
Hearing screening |
665 |
665 |
$1K |
| 90670 |
|
15 |
15 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
151 |
149 |
$1K |
| 90461 |
|
110 |
105 |
$1K |
| 99173 |
|
667 |
667 |
$807.72 |
| 88150 |
|
140 |
140 |
$750.92 |
| 59050 |
|
17 |
12 |
$629.89 |
| 81025 |
|
142 |
140 |
$491.43 |
| 36415 |
Collection of venous blood by venipuncture |
117 |
115 |
$480.49 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
14 |
$440.00 |
| 97802 |
|
162 |
158 |
$260.59 |
| 82947 |
|
191 |
181 |
$227.09 |
| 92551 |
|
46 |
46 |
$95.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
17 |
17 |
$89.37 |
| 81001 |
|
48 |
43 |
$84.66 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$70.00 |
| 81003 |
|
27 |
26 |
$15.39 |
| D1330 |
|
1,454 |
1,431 |
$0.00 |
| 99000 |
|
109 |
100 |
$0.00 |
| 99070 |
|
15 |
15 |
$0.00 |