| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,839 |
7,332 |
$1.54M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,437 |
6,685 |
$1.18M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,287 |
3,070 |
$503K |
| D1999 |
|
2,487 |
2,248 |
$23K |
| D1206 |
Topical application of fluoride varnish |
4,422 |
3,926 |
$17K |
| 90686 |
|
1,304 |
1,295 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
277 |
272 |
$13K |
| D1120 |
Prophylaxis - child |
2,015 |
2,008 |
$13K |
| 36415 |
Collection of venous blood by venipuncture |
2,758 |
2,615 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
429 |
317 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
149 |
147 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
2,236 |
2,231 |
$11K |
| H0046 |
Mental health services, not otherwise specified |
104 |
103 |
$6K |
| D1351 |
Sealant - per tooth |
451 |
154 |
$6K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
753 |
718 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28 |
28 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
452 |
$4K |
| D1110 |
Prophylaxis - adult |
796 |
796 |
$4K |
| 83655 |
|
260 |
258 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
121 |
121 |
$3K |
| D0274 |
Bitewings - four radiographic images |
871 |
871 |
$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 |
75 |
67 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
12 |
$2K |
| 0012A |
|
46 |
44 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| 85018 |
|
481 |
476 |
$986.14 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
137 |
126 |
$728.00 |
| 0011A |
|
20 |
20 |
$684.07 |
| D0330 |
Panoramic radiographic image |
515 |
515 |
$578.88 |
| 99173 |
|
316 |
309 |
$577.55 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
12 |
$562.53 |
| 90656 |
|
31 |
31 |
$488.64 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
16 |
15 |
$423.96 |
| 90651 |
|
30 |
29 |
$315.63 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
19 |
19 |
$314.45 |
| 90734 |
|
28 |
28 |
$305.55 |
| 99177 |
|
17 |
17 |
$278.10 |
| 90670 |
|
27 |
26 |
$273.00 |
| 90633 |
|
26 |
26 |
$270.74 |
| D0272 |
Bitewings - two radiographic images |
250 |
248 |
$203.04 |
| 90707 |
|
15 |
14 |
$141.96 |
| 90716 |
|
15 |
14 |
$141.96 |
| 90619 |
|
12 |
12 |
$131.04 |
| 90647 |
|
13 |
12 |
$120.12 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
17 |
$92.80 |
| D0220 |
Intraoral - periapical first radiographic image |
517 |
514 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
37 |
$0.00 |
| D0270 |
|
47 |
46 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
691 |
358 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
127 |
125 |
$0.00 |