| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,817 |
12,470 |
$1.03M |
| D1110 |
Prophylaxis - adult |
6,357 |
3,327 |
$73K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,961 |
1,544 |
$44K |
| D0330 |
Panoramic radiographic image |
2,297 |
1,034 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
6,452 |
3,306 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,216 |
1,680 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
452 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
944 |
404 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
810 |
345 |
$24K |
| D1120 |
Prophylaxis - child |
2,640 |
1,327 |
$23K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,168 |
589 |
$22K |
| D0274 |
Bitewings - four radiographic images |
3,889 |
2,020 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
2,345 |
1,270 |
$18K |
| D1206 |
Topical application of fluoride varnish |
2,520 |
1,105 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
659 |
467 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
287 |
163 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
986 |
370 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,328 |
882 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
855 |
488 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,934 |
1,317 |
$6K |
| D1351 |
Sealant - per tooth |
198 |
44 |
$3K |
| 90688 |
|
833 |
428 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,519 |
444 |
$3K |
| 90651 |
|
405 |
225 |
$3K |
| D0272 |
Bitewings - two radiographic images |
561 |
268 |
$2K |
| 90480 |
|
102 |
63 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
25 |
$1K |
| 90715 |
|
347 |
181 |
$602.66 |
| 90620 |
|
103 |
58 |
$540.72 |
| 91322 |
|
13 |
13 |
$491.65 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
110 |
44 |
$475.68 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
21 |
12 |
$443.84 |
| 90734 |
|
503 |
295 |
$363.43 |
| 36415 |
Collection of venous blood by venipuncture |
153 |
88 |
$294.18 |
| 91320 |
|
24 |
14 |
$264.10 |
| 90656 |
|
22 |
22 |
$180.99 |
| 90619 |
|
288 |
129 |
$158.06 |
| 92551 |
|
37 |
26 |
$79.64 |
| 90633 |
|
130 |
78 |
$50.00 |