| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
45,832 |
33,267 |
$5.53M |
| D0999 |
Unspecified diagnostic procedure, by report |
4,488 |
3,729 |
$494K |
| 90651 |
|
1,854 |
1,458 |
$23K |
| 90734 |
|
1,307 |
930 |
$11K |
| 90620 |
|
1,023 |
790 |
$9K |
| 90686 |
|
5,054 |
4,051 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,797 |
9,754 |
$2K |
| 90710 |
|
594 |
386 |
$2K |
| 90633 |
|
1,946 |
1,471 |
$2K |
| 90670 |
|
3,080 |
2,327 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,520 |
7,167 |
$2K |
| 90715 |
|
749 |
513 |
$1K |
| 90696 |
|
562 |
368 |
$953.13 |
| 90698 |
|
2,048 |
1,394 |
$921.04 |
| 90716 |
|
654 |
459 |
$779.85 |
| 90685 |
|
464 |
335 |
$486.68 |
| 90707 |
|
602 |
415 |
$476.72 |
| 90744 |
|
1,142 |
778 |
$450.26 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,616 |
2,227 |
$283.73 |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,167 |
1,977 |
$205.56 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,225 |
2,569 |
$187.89 |
| 99381 |
|
365 |
318 |
$142.04 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,926 |
3,140 |
$128.61 |
| 99201 |
|
467 |
235 |
$118.20 |
| 90680 |
|
1,066 |
690 |
$116.40 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,826 |
2,227 |
$96.45 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,153 |
2,599 |
$64.30 |
| D0120 |
Periodic oral evaluation - established patient |
1,054 |
961 |
$61.08 |
| D0140 |
Limited oral evaluation - problem focused |
506 |
474 |
$47.78 |
| D0220 |
Intraoral - periapical first radiographic image |
1,312 |
1,211 |
$46.76 |
| D1120 |
Prophylaxis - child |
1,158 |
1,058 |
$44.10 |
| D1110 |
Prophylaxis - adult |
46 |
43 |
$41.00 |
| 81002 |
|
1,366 |
1,048 |
$28.53 |
| D1208 |
Topical application of fluoride, excluding varnish |
526 |
477 |
$25.73 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,091 |
1,606 |
$24.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
790 |
715 |
$22.18 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
589 |
536 |
$21.05 |
| D0274 |
Bitewings - four radiographic images |
220 |
189 |
$16.90 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
798 |
642 |
$16.18 |
| 81025 |
|
477 |
371 |
$7.74 |
| 82962 |
|
544 |
385 |
$1.68 |
| D0272 |
Bitewings - two radiographic images |
238 |
215 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
180 |
151 |
$0.00 |
| D1330 |
|
1,359 |
1,178 |
$0.00 |
| 90647 |
|
764 |
718 |
$0.00 |
| 90723 |
|
666 |
649 |
$0.00 |
| 96127 |
|
189 |
184 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
37 |
$0.00 |
| 90619 |
|
340 |
335 |
$0.00 |
| D1310 |
|
275 |
223 |
$0.00 |
| 90677 |
|
102 |
102 |
$0.00 |
| 99383 |
|
24 |
24 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
39 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
45 |
29 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$0.00 |
| 99173 |
|
594 |
469 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
789 |
695 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
312 |
267 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
341 |
260 |
$0.00 |
| 90681 |
|
463 |
439 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
79 |
54 |
$0.00 |
| 90700 |
|
289 |
266 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
297 |
243 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
27 |
$0.00 |
| 90713 |
|
35 |
31 |
$0.00 |
| 90682 |
|
19 |
17 |
$0.00 |