| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,691 |
4,444 |
$1.01M |
| D9450 |
|
20,102 |
11,976 |
$930K |
| D1110 |
Prophylaxis - adult |
4,767 |
3,794 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
2,118 |
1,780 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,029 |
562 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
303 |
208 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,792 |
1,238 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
4,589 |
3,752 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,903 |
1,483 |
$54K |
| D1120 |
Prophylaxis - child |
1,097 |
991 |
$53K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
366 |
241 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,899 |
1,260 |
$48K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
241 |
182 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,949 |
1,579 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,600 |
1,253 |
$36K |
| D1351 |
Sealant - per tooth |
941 |
197 |
$36K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
790 |
784 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,975 |
1,697 |
$26K |
| 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 |
601 |
544 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
837 |
735 |
$22K |
| 99050 |
|
392 |
390 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
269 |
269 |
$18K |
| D0180 |
|
1,411 |
1,104 |
$18K |
| D4341 |
|
311 |
114 |
$17K |
| D3320 |
|
70 |
54 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
427 |
323 |
$15K |
| D1206 |
Topical application of fluoride varnish |
556 |
532 |
$15K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
380 |
236 |
$14K |
| D4342 |
|
311 |
92 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
212 |
212 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
411 |
356 |
$10K |
| D2331 |
|
272 |
188 |
$10K |
| D9110 |
|
270 |
227 |
$9K |
| D2330 |
|
266 |
182 |
$8K |
| D0272 |
Bitewings - two radiographic images |
312 |
271 |
$8K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
530 |
526 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
39 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
418 |
415 |
$6K |
| 92015 |
Determination of refractive state |
496 |
496 |
$6K |
| D2332 |
|
63 |
43 |
$3K |
| D2954 |
|
75 |
46 |
$3K |
| D5211 |
|
12 |
12 |
$3K |
| 92341 |
|
78 |
78 |
$3K |
| D5212 |
|
20 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
229 |
129 |
$2K |
| D0270 |
|
459 |
328 |
$2K |
| D2335 |
|
55 |
37 |
$2K |
| 81003 |
|
171 |
170 |
$338.58 |
| 81025 |
|
29 |
29 |
$220.11 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
500 |
462 |
$0.00 |
| 94760 |
|
21 |
21 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
12 |
12 |
$0.00 |