| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
27,774 |
20,978 |
$2.03M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,165 |
7,830 |
$257K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,533 |
3,252 |
$94K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,778 |
1,598 |
$82K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,108 |
1,167 |
$60K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,945 |
1,021 |
$48K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,104 |
2,303 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,601 |
829 |
$32K |
| D1110 |
Prophylaxis - adult |
2,733 |
1,953 |
$32K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,148 |
643 |
$31K |
| D0330 |
Panoramic radiographic image |
2,395 |
1,567 |
$19K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
479 |
288 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,175 |
2,379 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,775 |
1,300 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,422 |
975 |
$12K |
| D0274 |
Bitewings - four radiographic images |
2,830 |
1,949 |
$12K |
| 90677 |
|
129 |
99 |
$11K |
| D1206 |
Topical application of fluoride varnish |
1,347 |
988 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,443 |
1,593 |
$10K |
| D1120 |
Prophylaxis - child |
1,015 |
771 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
4,223 |
2,856 |
$6K |
| 96160 |
|
3,928 |
2,340 |
$5K |
| 90686 |
|
723 |
420 |
$5K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
264 |
240 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
562 |
355 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,034 |
707 |
$3K |
| 99188 |
|
265 |
177 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
562 |
288 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
15 |
$2K |
| 0012A |
|
44 |
44 |
$1K |
| 0011A |
|
66 |
65 |
$952.08 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
139 |
73 |
$936.03 |
| 90670 |
|
968 |
563 |
$779.50 |
| 90688 |
|
216 |
138 |
$662.56 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
25 |
12 |
$492.00 |
| 90633 |
|
278 |
161 |
$397.00 |
| 90715 |
|
82 |
42 |
$357.25 |
| 90698 |
|
733 |
430 |
$315.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
20 |
13 |
$291.69 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
47 |
26 |
$168.00 |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
13 |
$147.08 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
261 |
163 |
$143.74 |
| 90658 |
|
205 |
123 |
$126.76 |
| D2140 |
|
53 |
37 |
$95.50 |
| D1354 |
|
313 |
186 |
$65.23 |
| D2160 |
|
13 |
12 |
$65.00 |
| 90744 |
|
190 |
114 |
$40.00 |
| 90685 |
|
108 |
67 |
$20.00 |
| 90651 |
|
65 |
31 |
$10.10 |
| 90734 |
|
83 |
39 |
$10.00 |
| 3079F |
|
1,429 |
1,196 |
$0.21 |
| 3074F |
|
3,862 |
3,274 |
$0.15 |
| 3075F |
|
798 |
722 |
$0.14 |
| 3078F |
|
4,163 |
3,079 |
$0.12 |
| 3077F |
|
753 |
658 |
$0.05 |
| 3080F |
|
547 |
442 |
$0.02 |
| 3008F |
|
6,705 |
4,096 |
$0.00 |
| D0603 |
|
392 |
277 |
$0.00 |
| 91301 |
|
134 |
127 |
$0.00 |
| D1351 |
Sealant - per tooth |
50 |
13 |
$0.00 |
| 90656 |
|
23 |
23 |
$0.00 |
| 90681 |
|
27 |
13 |
$0.00 |