| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
47,171 |
34,834 |
$3.44M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20,439 |
11,354 |
$395K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,656 |
4,518 |
$220K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
10,573 |
6,558 |
$182K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,903 |
2,380 |
$114K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,657 |
2,152 |
$84K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,205 |
1,257 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,630 |
2,183 |
$31K |
| D1351 |
Sealant - per tooth |
2,003 |
315 |
$31K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
776 |
482 |
$26K |
| D0330 |
Panoramic radiographic image |
4,253 |
2,774 |
$23K |
| 90651 |
|
320 |
221 |
$20K |
| D1206 |
Topical application of fluoride varnish |
2,929 |
1,893 |
$19K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,353 |
794 |
$16K |
| D1110 |
Prophylaxis - adult |
2,801 |
1,977 |
$14K |
| 90671 |
|
156 |
112 |
$14K |
| D1120 |
Prophylaxis - child |
1,242 |
907 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
3,194 |
2,344 |
$13K |
| 90686 |
|
2,701 |
1,603 |
$13K |
| 90677 |
|
157 |
145 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,103 |
2,026 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,916 |
1,145 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
364 |
265 |
$11K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
366 |
197 |
$8K |
| D0274 |
Bitewings - four radiographic images |
4,320 |
2,945 |
$7K |
| 96160 |
|
6,042 |
3,463 |
$7K |
| 90688 |
|
878 |
547 |
$6K |
| 99401 |
|
305 |
282 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,028 |
552 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
3,243 |
2,120 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,324 |
836 |
$6K |
| 90670 |
|
2,622 |
1,663 |
$6K |
| D1354 |
|
1,625 |
402 |
$5K |
| 90698 |
|
2,436 |
1,546 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
6,815 |
4,592 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,914 |
3,534 |
$5K |
| 90734 |
|
138 |
106 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,473 |
1,075 |
$4K |
| 90633 |
|
1,445 |
981 |
$4K |
| 99188 |
|
503 |
319 |
$3K |
| 90744 |
|
1,703 |
1,044 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
569 |
290 |
$2K |
| 99381 |
|
103 |
61 |
$2K |
| D2140 |
|
280 |
137 |
$2K |
| D0272 |
Bitewings - two radiographic images |
174 |
166 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
668 |
366 |
$1K |
| 90681 |
|
726 |
459 |
$1K |
| 90756 |
|
172 |
99 |
$1K |
| 0012A |
|
53 |
53 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
32 |
16 |
$1K |
| 90682 |
|
30 |
21 |
$979.16 |
| 90715 |
|
252 |
157 |
$927.87 |
| 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 |
99 |
90 |
$510.28 |
| 90716 |
|
406 |
293 |
$383.50 |
| 99402 |
|
14 |
14 |
$361.10 |
| 90707 |
|
177 |
125 |
$270.50 |
| 90685 |
|
269 |
175 |
$206.00 |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
13 |
$180.00 |
| 90658 |
|
363 |
226 |
$175.07 |
| 90656 |
|
141 |
139 |
$62.00 |
| 90713 |
|
27 |
19 |
$10.00 |
| 3078F |
|
7,318 |
5,385 |
$0.44 |
| 3074F |
|
6,518 |
5,640 |
$0.41 |
| 3079F |
|
1,619 |
1,261 |
$0.21 |
| 3075F |
|
556 |
515 |
$0.10 |
| 3077F |
|
179 |
146 |
$0.05 |
| D0191 |
|
749 |
494 |
$0.00 |
| 90700 |
|
80 |
54 |
$0.00 |
| D0270 |
|
72 |
55 |
$0.00 |
| 90710 |
|
40 |
25 |
$0.00 |
| 90648 |
|
41 |
26 |
$0.00 |
| 3008F |
|
10,002 |
5,915 |
$0.00 |
| D9995 |
|
181 |
98 |
$0.00 |
| D0603 |
|
337 |
290 |
$0.00 |
| 91301 |
|
106 |
105 |
$0.00 |
| 90619 |
|
16 |
12 |
$0.00 |
| D2160 |
|
63 |
43 |
$0.00 |
| 3080F |
|
24 |
13 |
$0.00 |