| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
28,738 |
22,079 |
$5.95M |
| D9999 |
Unspecified adjunctive procedure, by report |
19,308 |
15,734 |
$3.69M |
| D0999 |
Unspecified diagnostic procedure, by report |
6,501 |
5,744 |
$1.45M |
| D0120 |
Periodic oral evaluation - established patient |
10,100 |
9,636 |
$32K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,522 |
7,975 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,687 |
2,570 |
$29K |
| D1120 |
Prophylaxis - child |
6,618 |
6,289 |
$26K |
| D1206 |
Topical application of fluoride varnish |
9,402 |
8,904 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,201 |
1,540 |
$17K |
| D1110 |
Prophylaxis - adult |
5,498 |
5,275 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,025 |
3,833 |
$8K |
| D0274 |
Bitewings - four radiographic images |
3,924 |
3,832 |
$8K |
| D0330 |
Panoramic radiographic image |
2,857 |
2,758 |
$7K |
| D1999 |
|
27 |
24 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,502 |
1,361 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
925 |
892 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,759 |
1,029 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,685 |
1,605 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
1,966 |
1,874 |
$3K |
| D1351 |
Sealant - per tooth |
1,490 |
429 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,374 |
1,324 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
377 |
325 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,457 |
2,344 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
456 |
440 |
$691.28 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,071 |
1,061 |
$533.35 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,508 |
4,353 |
$477.03 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,093 |
1,932 |
$335.63 |
| D2331 |
|
49 |
38 |
$293.72 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,661 |
1,652 |
$240.09 |
| D2330 |
|
32 |
24 |
$233.62 |
| 85018 |
|
1,123 |
1,062 |
$151.61 |
| W0037 |
|
39 |
39 |
$117.00 |
| 36415 |
Collection of venous blood by venipuncture |
2,488 |
2,256 |
$97.96 |
| D1354 |
|
114 |
47 |
$78.45 |
| 90461 |
|
3,412 |
2,340 |
$61.42 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
288 |
257 |
$61.08 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
334 |
327 |
$58.55 |
| D1353 |
|
56 |
19 |
$41.01 |
| 90686 |
|
753 |
727 |
$28.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
876 |
341 |
$21.46 |
| 87430 |
|
94 |
93 |
$17.04 |
| 99173 |
|
15 |
15 |
$8.85 |
| 81003 |
|
305 |
276 |
$4.11 |
| 36416 |
|
1,425 |
1,383 |
$3.17 |
| D4346 |
|
30 |
30 |
$0.17 |
| D4341 |
|
40 |
12 |
$0.12 |
| D4910 |
|
24 |
24 |
$0.10 |
| 83655 |
|
431 |
429 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,153 |
1,082 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
216 |
211 |
$0.00 |
| 90670 |
|
201 |
201 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
468 |
264 |
$0.00 |
| 90715 |
|
127 |
121 |
$0.00 |
| D0190 |
|
12 |
12 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
21 |
18 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
18 |
17 |
$0.00 |
| 99188 |
|
33 |
33 |
$0.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
51 |
51 |
$0.00 |
| 87428 |
|
504 |
478 |
$0.00 |
| 90647 |
|
109 |
109 |
$0.00 |
| 90656 |
|
95 |
90 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,498 |
774 |
$0.00 |
| 90723 |
|
92 |
92 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
52 |
52 |
$0.00 |
| 87807 |
|
46 |
40 |
$0.00 |
| 99385 |
|
12 |
12 |
$0.00 |
| 99381 |
|
24 |
24 |
$0.00 |
| 90480 |
|
14 |
14 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
15 |
14 |
$0.00 |
| 92002 |
|
29 |
13 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |
| 82950 |
|
15 |
15 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
16 |
15 |
$0.00 |