| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
68,839 |
60,198 |
$7.24M |
| D0140 |
Limited oral evaluation - problem focused |
20,656 |
19,947 |
$500K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,493 |
6,107 |
$469K |
| D0220 |
Intraoral - periapical first radiographic image |
34,835 |
33,579 |
$288K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,315 |
6,215 |
$198K |
| D0330 |
Panoramic radiographic image |
7,033 |
6,892 |
$195K |
| D1110 |
Prophylaxis - adult |
4,502 |
4,399 |
$174K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,292 |
4,932 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
6,952 |
6,871 |
$163K |
| D1206 |
Topical application of fluoride varnish |
8,763 |
8,579 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,941 |
1,669 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,305 |
1,712 |
$100K |
| D0274 |
Bitewings - four radiographic images |
9,104 |
8,956 |
$97K |
| D0415 |
|
3,971 |
3,584 |
$80K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,188 |
1,135 |
$59K |
| D1999 |
|
4,916 |
4,282 |
$56K |
| D4341 |
|
2,064 |
1,052 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,662 |
15,926 |
$44K |
| D0270 |
|
2,914 |
2,857 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,858 |
2,793 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
230 |
194 |
$23K |
| D0604 |
|
2,787 |
2,546 |
$22K |
| D1120 |
Prophylaxis - child |
1,053 |
1,017 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
298 |
243 |
$15K |
| D2140 |
|
233 |
207 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
170 |
170 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
44 |
$5K |
| D2331 |
|
84 |
63 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
265 |
257 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
168 |
162 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
221 |
193 |
$2K |
| D2330 |
|
40 |
24 |
$2K |
| 90746 |
|
13 |
13 |
$702.26 |
| 81002 |
|
259 |
256 |
$601.60 |
| 90715 |
|
19 |
19 |
$557.28 |
| D1351 |
Sealant - per tooth |
39 |
14 |
$549.50 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
20 |
20 |
$480.00 |
| 83037 |
|
42 |
42 |
$460.32 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
40 |
40 |
$421.50 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
26 |
24 |
$404.56 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
24 |
24 |
$324.72 |
| 81025 |
|
99 |
96 |
$318.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$284.06 |
| D4342 |
|
21 |
12 |
$240.19 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
19 |
17 |
$145.73 |
| 82947 |
|
12 |
12 |
$44.40 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
12 |
$32.11 |
| 3077F |
|
101 |
94 |
$0.00 |
| 3078F |
|
666 |
615 |
$0.00 |
| 3075F |
|
122 |
121 |
$0.00 |
| 3074F |
|
624 |
584 |
$0.00 |
| 3079F |
|
164 |
157 |
$0.00 |
| 3080F |
|
27 |
27 |
$0.00 |