| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,986 |
13,316 |
$3.33M |
| D0999 |
Unspecified diagnostic procedure, by report |
3,885 |
3,420 |
$952K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,325 |
2,301 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,689 |
8,832 |
$12K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
155 |
153 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
308 |
287 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
207 |
207 |
$2K |
| 0001A |
|
70 |
69 |
$2K |
| 90686 |
|
1,064 |
1,061 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
27 |
$1K |
| 0002A |
|
44 |
44 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
294 |
288 |
$913.30 |
| 90473 |
|
69 |
69 |
$896.70 |
| 87428 |
|
17 |
17 |
$240.00 |
| 90656 |
|
61 |
61 |
$231.27 |
| 90651 |
|
15 |
15 |
$210.00 |
| 90474 |
|
15 |
15 |
$144.96 |
| 90672 |
|
180 |
180 |
$140.95 |
| 2001F |
|
3,449 |
3,150 |
$101.73 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
92 |
90 |
$76.06 |
| 90715 |
|
12 |
12 |
$27.86 |
| 90688 |
|
13 |
13 |
$8.34 |
| D0274 |
Bitewings - four radiographic images |
796 |
796 |
$0.00 |
| D1110 |
Prophylaxis - adult |
680 |
680 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,127 |
1,113 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
1,048 |
970 |
$0.00 |
| 3078F |
|
2,143 |
1,993 |
$0.00 |
| 1159F |
|
1,836 |
1,668 |
$0.00 |
| D0330 |
Panoramic radiographic image |
437 |
437 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
146 |
144 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
129 |
120 |
$0.00 |
| 91300 |
|
266 |
246 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
24 |
24 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
30 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
28 |
28 |
$0.00 |
| 4004F |
|
230 |
205 |
$0.00 |
| 3077F |
|
13 |
12 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
14 |
13 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$0.00 |
| 3074F |
|
2,524 |
2,325 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,809 |
616 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
443 |
438 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
623 |
623 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
376 |
376 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
1,106 |
1,024 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
238 |
237 |
$0.00 |
| 1111F |
|
483 |
453 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
65 |
$0.00 |
| 3079F |
|
582 |
552 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
22 |
$0.00 |
| 3075F |
|
36 |
36 |
$0.00 |