| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,643 |
5,557 |
$1.33M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,088 |
2,910 |
$600K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,543 |
2,466 |
$537K |
| 90837 |
Psychotherapy, 53 minutes with patient |
451 |
265 |
$68K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
279 |
278 |
$41K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
199 |
196 |
$39K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
174 |
173 |
$32K |
| D1999 |
|
3,386 |
3,115 |
$29K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
59 |
57 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
44 |
41 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
24 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
26 |
25 |
$6K |
| 90834 |
Psychotherapy, 45 minutes with patient |
29 |
13 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
26 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
381 |
356 |
$4K |
| 99215 |
Prolong outpt/office vis |
16 |
13 |
$3K |
| 90686 |
|
243 |
241 |
$3K |
| D1120 |
Prophylaxis - child |
1,793 |
1,772 |
$1K |
| D1206 |
Topical application of fluoride varnish |
2,840 |
2,799 |
$1K |
| 92552 |
|
38 |
35 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
640 |
$774.33 |
| 83655 |
|
53 |
53 |
$595.92 |
| 85018 |
|
237 |
236 |
$522.24 |
| D1351 |
Sealant - per tooth |
475 |
149 |
$442.63 |
| 36416 |
|
141 |
126 |
$381.69 |
| D0120 |
Periodic oral evaluation - established patient |
1,514 |
1,489 |
$380.34 |
| 99173 |
|
43 |
43 |
$253.99 |
| D1110 |
Prophylaxis - adult |
167 |
163 |
$242.31 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
44 |
$219.20 |
| D0140 |
Limited oral evaluation - problem focused |
93 |
89 |
$158.66 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
85 |
$152.18 |
| D0220 |
Intraoral - periapical first radiographic image |
1,686 |
1,663 |
$147.30 |
| D0330 |
Panoramic radiographic image |
412 |
408 |
$134.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,992 |
1,412 |
$66.67 |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
50 |
$56.29 |
| D0240 |
|
801 |
409 |
$50.34 |
| D0272 |
Bitewings - two radiographic images |
829 |
821 |
$33.56 |
| D0145 |
Oral evaluation for a patient under three years of age |
238 |
238 |
$28.25 |
| D0274 |
Bitewings - four radiographic images |
912 |
902 |
$27.03 |
| 3008F |
|
344 |
326 |
$0.29 |
| D0999 |
Unspecified diagnostic procedure, by report |
44 |
36 |
$0.00 |
| 3077F |
|
13 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
54 |
$0.00 |