| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,920 |
5,433 |
$938K |
| D0999 |
Unspecified diagnostic procedure, by report |
8,250 |
6,786 |
$917K |
| 90686 |
|
69 |
55 |
$191.83 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,684 |
1,863 |
$10.69 |
| D1206 |
Topical application of fluoride varnish |
783 |
772 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
396 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,243 |
1,212 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
67 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
506 |
433 |
$0.00 |
| D0603 |
|
269 |
260 |
$0.00 |
| 99000 |
|
897 |
653 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,169 |
1,149 |
$0.00 |
| D0602 |
|
136 |
133 |
$0.00 |
| 1036F |
|
119 |
107 |
$0.00 |
| D1310 |
|
312 |
311 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
190 |
98 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
992 |
941 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
396 |
374 |
$0.00 |
| 81000 |
|
95 |
41 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
499 |
487 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
565 |
373 |
$0.00 |
| 96127 |
|
474 |
356 |
$0.00 |
| 90723 |
|
33 |
12 |
$0.00 |
| 3008F |
|
62 |
59 |
$0.00 |
| D1351 |
Sealant - per tooth |
139 |
40 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
46 |
45 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |
| 1126F |
|
39 |
37 |
$0.00 |
| D0601 |
|
105 |
101 |
$0.00 |
| 90651 |
|
16 |
12 |
$0.00 |
| 3074F |
|
32 |
30 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,043 |
1,009 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
67 |
29 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
593 |
580 |
$0.00 |
| D1120 |
Prophylaxis - child |
991 |
974 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
529 |
313 |
$0.00 |
| 3725F |
|
64 |
61 |
$0.00 |
| D9110 |
|
124 |
113 |
$0.00 |
| D1110 |
Prophylaxis - adult |
298 |
288 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,276 |
1,653 |
$0.00 |
| D0270 |
|
484 |
465 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
681 |
540 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
27 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
94 |
84 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
126 |
41 |
$0.00 |
| 0502F |
|
89 |
43 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
107 |
39 |
$0.00 |
| 90670 |
|
70 |
24 |
$0.00 |
| D0330 |
Panoramic radiographic image |
81 |
80 |
$0.00 |
| 1160F |
|
128 |
122 |
$0.00 |
| D2140 |
|
16 |
13 |
$0.00 |
| 90648 |
|
89 |
39 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
75 |
62 |
$0.00 |
| 3078F |
|
28 |
26 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
55 |
42 |
$0.00 |