| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,346 |
3,822 |
$411K |
| 90832 |
Psychotherapy, 30 minutes with patient |
4,264 |
1,703 |
$99K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,503 |
1,497 |
$62K |
| D1354 |
|
781 |
147 |
$20K |
| D0330 |
Panoramic radiographic image |
573 |
381 |
$20K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
367 |
142 |
$19K |
| 92587 |
|
1,543 |
837 |
$15K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
447 |
257 |
$15K |
| 92015 |
Determination of refractive state |
1,270 |
702 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
331 |
$9K |
| 99188 |
|
514 |
421 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
563 |
301 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
193 |
$6K |
| 99384 |
|
144 |
86 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
244 |
131 |
$4K |
| 81025 |
|
1,050 |
446 |
$3K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
85 |
78 |
$3K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
411 |
330 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
381 |
144 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
411 |
258 |
$2K |
| 86703 |
|
324 |
261 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
145 |
128 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
97 |
88 |
$1K |
| 82962 |
|
709 |
383 |
$819.54 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
24 |
13 |
$675.48 |
| D1206 |
Topical application of fluoride varnish |
123 |
73 |
$600.00 |
| D0120 |
Periodic oral evaluation - established patient |
16 |
16 |
$536.96 |
| 96127 |
|
170 |
135 |
$452.31 |
| D0274 |
Bitewings - four radiographic images |
97 |
68 |
$354.40 |
| D0272 |
Bitewings - two radiographic images |
111 |
68 |
$286.15 |
| D1120 |
Prophylaxis - child |
37 |
18 |
$280.00 |
| 99173 |
|
175 |
85 |
$191.52 |
| 90619 |
|
275 |
158 |
$160.53 |
| D0270 |
|
31 |
19 |
$104.50 |
| 90686 |
|
51 |
27 |
$66.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
13 |
$49.72 |
| 90715 |
|
116 |
64 |
$10.00 |
| 3044F |
|
593 |
331 |
$0.00 |
| 1036F |
|
1,770 |
1,081 |
$0.00 |
| 90651 |
|
167 |
92 |
$0.00 |
| 3008F |
|
365 |
290 |
$0.00 |
| 3074F |
|
85 |
38 |
$0.00 |
| 4004F |
|
211 |
79 |
$0.00 |
| 3078F |
|
13 |
13 |
$0.00 |
| 90734 |
|
32 |
15 |
$0.00 |