| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,406 |
12,435 |
$1.09M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,883 |
3,192 |
$127K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,429 |
2,109 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,197 |
485 |
$55K |
| D0330 |
Panoramic radiographic image |
2,296 |
1,445 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,257 |
1,427 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
786 |
435 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
118 |
29 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,213 |
1,445 |
$20K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
818 |
438 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,766 |
1,014 |
$18K |
| D1110 |
Prophylaxis - adult |
971 |
584 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
371 |
156 |
$12K |
| D1120 |
Prophylaxis - child |
775 |
530 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
630 |
301 |
$8K |
| 90791 |
Psychiatric diagnostic evaluation |
194 |
80 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
249 |
137 |
$7K |
| D1206 |
Topical application of fluoride varnish |
549 |
374 |
$7K |
| D1351 |
Sealant - per tooth |
459 |
90 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
705 |
418 |
$7K |
| 99384 |
|
179 |
95 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
179 |
119 |
$6K |
| 92015 |
Determination of refractive state |
1,586 |
1,257 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,135 |
808 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
105 |
76 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
86 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,674 |
1,119 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
610 |
389 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,636 |
953 |
$4K |
| 92551 |
|
1,199 |
706 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
532 |
382 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
88 |
50 |
$3K |
| D0240 |
|
138 |
59 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
82 |
45 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
605 |
219 |
$2K |
| 99381 |
|
72 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
168 |
129 |
$2K |
| D1354 |
|
124 |
34 |
$2K |
| 99383 |
|
25 |
13 |
$746.57 |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
47 |
$619.28 |
| 90734 |
|
443 |
276 |
$609.44 |
| 99173 |
|
337 |
226 |
$466.08 |
| 90651 |
|
267 |
165 |
$270.86 |
| 90658 |
|
162 |
90 |
$242.09 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
12 |
$176.05 |
| 90715 |
|
314 |
197 |
$150.77 |
| 90661 |
|
49 |
46 |
$107.77 |
| 90723 |
|
329 |
182 |
$92.82 |
| 90686 |
|
112 |
70 |
$39.55 |
| 92341 |
|
23 |
14 |
$26.97 |
| 90670 |
|
552 |
298 |
$1.02 |
| 90633 |
|
264 |
154 |
$0.95 |
| 90647 |
|
206 |
107 |
$0.23 |
| 90681 |
|
96 |
51 |
$0.16 |
| 90710 |
|
102 |
59 |
$0.12 |
| 90656 |
|
39 |
27 |
$0.10 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
4,945 |
3,115 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
482 |
231 |
$0.00 |
| 3078F |
|
4,288 |
2,807 |
$0.00 |
| 4004F |
|
391 |
309 |
$0.00 |
| 3077F |
|
530 |
260 |
$0.00 |
| V2020 |
Frames, purchases |
15 |
15 |
$0.00 |
| 90671 |
|
13 |
13 |
$0.00 |
| 2001F |
|
6,762 |
4,318 |
$0.00 |
| 3079F |
|
1,344 |
823 |
$0.00 |
| 1036F |
|
4,173 |
2,695 |
$0.00 |
| 3008F |
|
6,796 |
4,347 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
159 |
79 |
$0.00 |
| 3074F |
|
4,700 |
3,086 |
$0.00 |
| 90697 |
|
12 |
12 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
5,200 |
3,246 |
$0.00 |
| 3075F |
|
281 |
166 |
$0.00 |
| 3048F |
|
14 |
14 |
$0.00 |
| 3080F |
|
79 |
39 |
$0.00 |
| 90657 |
|
31 |
18 |
$0.00 |