| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
11,935 |
10,275 |
$806K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,017 |
1,226 |
$64K |
| D1110 |
Prophylaxis - adult |
4,051 |
2,877 |
$57K |
| D0274 |
Bitewings - four radiographic images |
4,376 |
3,090 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
4,589 |
3,301 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,562 |
938 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,922 |
2,036 |
$22K |
| D1120 |
Prophylaxis - child |
2,697 |
1,874 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,554 |
1,115 |
$12K |
| D2140 |
|
609 |
308 |
$10K |
| D0330 |
Panoramic radiographic image |
499 |
352 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
346 |
198 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
93 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
347 |
179 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,242 |
928 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,199 |
862 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
99 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
333 |
225 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
972 |
691 |
$2K |
| 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 |
43 |
41 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
54 |
30 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
47 |
26 |
$41.81 |