| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
19,326 |
16,693 |
$4.88M |
| D0999 |
Unspecified diagnostic procedure, by report |
14,102 |
13,549 |
$3.81M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,544 |
2,434 |
$170K |
| 99381 |
|
727 |
699 |
$152K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,664 |
6,605 |
$47K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,097 |
3,009 |
$42K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,236 |
1,183 |
$12K |
| 90832 |
Psychotherapy, 30 minutes with patient |
124 |
117 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
537 |
510 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
417 |
385 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
53 |
53 |
$470.10 |
| D1120 |
Prophylaxis - child |
4,407 |
4,197 |
$404.25 |
| D0120 |
Periodic oral evaluation - established patient |
4,446 |
4,228 |
$403.90 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
17 |
16 |
$313.40 |
| D1110 |
Prophylaxis - adult |
251 |
245 |
$274.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,677 |
2,545 |
$176.40 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,634 |
4,238 |
$70.56 |
| D1206 |
Topical application of fluoride varnish |
2,110 |
2,023 |
$58.80 |
| 99000 |
|
3,217 |
3,040 |
$52.51 |
| D0272 |
Bitewings - two radiographic images |
408 |
392 |
$46.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,142 |
334 |
$34.53 |
| 0081A |
|
29 |
29 |
$29.70 |
| 92552 |
|
1,021 |
979 |
$26.38 |
| 90461 |
|
2,910 |
2,700 |
$13.42 |
| D0220 |
Intraoral - periapical first radiographic image |
455 |
422 |
$12.56 |
| 90680 |
|
1,509 |
1,450 |
$0.00 |
| 92551 |
|
470 |
451 |
$0.00 |
| D0602 |
|
1,861 |
1,786 |
$0.00 |
| 90686 |
|
2,777 |
2,721 |
$0.00 |
| D0603 |
|
10,453 |
10,104 |
$0.00 |
| 90696 |
|
163 |
150 |
$0.00 |
| 90651 |
|
282 |
268 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
38 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,748 |
1,715 |
$0.00 |
| 90698 |
|
1,372 |
1,325 |
$0.00 |
| 90744 |
|
698 |
678 |
$0.00 |
| 90716 |
|
388 |
367 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
98 |
97 |
$0.00 |
| D0601 |
|
533 |
500 |
$0.00 |
| 90656 |
|
71 |
71 |
$0.00 |
| 90697 |
|
191 |
175 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
69 |
$0.00 |
| 90677 |
|
57 |
57 |
$0.00 |
| 91307 |
|
206 |
188 |
$0.00 |
| 91305 |
|
15 |
12 |
$0.00 |
| 90474 |
|
96 |
96 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
65 |
62 |
$0.00 |
| 0072A |
|
12 |
12 |
$0.00 |
| 90710 |
|
168 |
154 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
8,075 |
7,847 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
365 |
269 |
$0.00 |
| 90734 |
|
85 |
82 |
$0.00 |
| 90707 |
|
387 |
367 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
505 |
490 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
644 |
614 |
$0.00 |
| 87420 |
|
46 |
45 |
$0.00 |
| 90633 |
|
929 |
881 |
$0.00 |
| 90473 |
|
238 |
233 |
$0.00 |
| 99173 |
|
1,994 |
1,934 |
$0.00 |
| 90670 |
|
2,316 |
2,215 |
$0.00 |
| 90700 |
|
286 |
268 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
304 |
291 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$0.00 |
| 90648 |
|
282 |
269 |
$0.00 |
| 0071A |
|
53 |
53 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
57 |
$0.00 |
| 91308 |
|
105 |
101 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17 |
12 |
$0.00 |
| 90715 |
|
13 |
12 |
$0.00 |