| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
113,500 |
84,017 |
$21.91M |
| 00003 |
Internal/system code - not a standard HCPCS code |
2,818 |
2,063 |
$612K |
| D1110 |
Prophylaxis - adult |
10,677 |
10,463 |
$142K |
| D1120 |
Prophylaxis - child |
6,188 |
6,130 |
$142K |
| D1206 |
Topical application of fluoride varnish |
11,903 |
11,833 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,169 |
5,928 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
13,987 |
13,712 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,982 |
12,739 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
7,496 |
7,319 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,633 |
4,134 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,798 |
8,601 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
19,737 |
17,776 |
$75K |
| D0274 |
Bitewings - four radiographic images |
11,469 |
11,291 |
$60K |
| D9430 |
|
10,262 |
9,477 |
$56K |
| D1351 |
Sealant - per tooth |
2,594 |
858 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,431 |
6,222 |
$42K |
| D4341 |
|
2,278 |
1,007 |
$40K |
| D9999 |
Unspecified adjunctive procedure, by report |
324 |
312 |
$28K |
| D2330 |
|
509 |
388 |
$13K |
| D0270 |
|
4,474 |
4,288 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
162 |
157 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
429 |
299 |
$4K |
| D2331 |
|
94 |
85 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
25 |
25 |
$2K |
| D0603 |
|
614 |
600 |
$468.85 |
| D9110 |
|
25 |
24 |
$445.00 |
| D2332 |
|
14 |
12 |
$195.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
692 |
692 |
$125.80 |
| D0602 |
|
128 |
126 |
$125.05 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$80.00 |
| D0601 |
|
57 |
57 |
$8.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
300 |
300 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
160 |
147 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,543 |
2,332 |
$0.00 |
| 98940 |
|
679 |
434 |
$0.00 |
| 3077F |
|
477 |
402 |
$0.00 |
| 99173 |
|
531 |
529 |
$0.00 |
| 97803 |
|
397 |
397 |
$0.00 |
| 99401 |
|
696 |
696 |
$0.00 |
| 92552 |
|
391 |
390 |
$0.00 |
| 81002 |
|
72 |
71 |
$0.00 |
| 81025 |
|
125 |
123 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
27 |
27 |
$0.00 |
| 88147 |
|
28 |
28 |
$0.00 |
| 83037 |
|
14 |
14 |
$0.00 |
| 3078F |
|
36 |
33 |
$0.00 |
| 0013A |
|
12 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
680 |
620 |
$0.00 |
| 3080F |
|
167 |
133 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,555 |
10,907 |
$0.00 |
| 90686 |
|
121 |
121 |
$0.00 |
| 90674 |
|
83 |
83 |
$0.00 |
| 85018 |
|
469 |
466 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
64 |
63 |
$0.00 |
| 3079F |
|
64 |
59 |
$0.00 |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
106 |
63 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
176 |
164 |
$0.00 |
| 3074F |
|
15 |
15 |
$0.00 |
| 0064A |
|
23 |
19 |
$0.00 |