| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
56,185 |
51,382 |
$5.00M |
| D1120 |
Prophylaxis - child |
22,799 |
19,118 |
$418K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,643 |
20,551 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
28,995 |
24,141 |
$192K |
| D1351 |
Sealant - per tooth |
11,365 |
3,364 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108,519 |
24,811 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,639 |
6,720 |
$174K |
| D0274 |
Bitewings - four radiographic images |
20,645 |
17,289 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
33,490 |
26,544 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,249 |
4,764 |
$116K |
| 00003 |
Internal/system code - not a standard HCPCS code |
751 |
600 |
$107K |
| D1310 |
|
32,865 |
26,164 |
$59K |
| D0170 |
|
2,319 |
1,601 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,150 |
4,381 |
$55K |
| D9430 |
|
3,367 |
2,706 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
1,388 |
1,138 |
$20K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,590 |
786 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
685 |
536 |
$15K |
| D0603 |
|
9,262 |
8,466 |
$15K |
| D0272 |
Bitewings - two radiographic images |
3,220 |
2,586 |
$12K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
678 |
538 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
156 |
$3K |
| D0270 |
|
920 |
700 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,834 |
1,448 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
153 |
123 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
25 |
25 |
$2K |
| D0601 |
|
77 |
77 |
$1K |
| D1320 |
|
422 |
405 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
986 |
794 |
$842.15 |
| D1999 |
|
13 |
13 |
$780.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
591 |
523 |
$668.95 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
614 |
512 |
$491.81 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$220.00 |
| 90686 |
|
1,070 |
842 |
$218.43 |
| 59425 |
|
96 |
79 |
$185.06 |
| 99381 |
|
90 |
84 |
$173.64 |
| 90670 |
|
744 |
643 |
$135.00 |
| 90633 |
|
536 |
431 |
$126.52 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
823 |
648 |
$77.99 |
| 90648 |
|
121 |
117 |
$63.78 |
| 90700 |
|
224 |
182 |
$45.00 |
| 90647 |
|
473 |
407 |
$36.00 |
| 90723 |
|
374 |
322 |
$36.00 |
| 90710 |
|
228 |
187 |
$36.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
320 |
251 |
$25.68 |
| 90688 |
|
14 |
14 |
$18.00 |
| 90716 |
|
106 |
77 |
$18.00 |
| 90651 |
|
156 |
123 |
$18.00 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
16 |
12 |
$16.82 |
| 85018 |
|
1,085 |
913 |
$11.77 |
| 90696 |
|
56 |
43 |
$9.00 |
| 90713 |
|
67 |
58 |
$9.00 |
| 99173 |
|
758 |
615 |
$5.89 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
129 |
97 |
$4.28 |
| 99383 |
|
71 |
56 |
$2.14 |
| 99384 |
|
18 |
14 |
$1.07 |
| 92551 |
|
562 |
446 |
$0.00 |
| D4355 |
|
270 |
222 |
$0.00 |
| D1330 |
|
26,360 |
20,832 |
$0.00 |
| D4999 |
|
1,560 |
1,262 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
574 |
474 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
1,529 |
1,136 |
$0.00 |
| 3048F |
|
103 |
73 |
$0.00 |
| 1036F |
|
450 |
345 |
$0.00 |
| D9995 |
|
2,147 |
1,326 |
$0.00 |
| 3074F |
|
1,486 |
1,107 |
$0.00 |
| Z6410 |
|
778 |
573 |
$0.00 |
| 3008F |
|
1,837 |
1,356 |
$0.00 |
| 90680 |
|
239 |
208 |
$0.00 |
| 2001F |
|
1,836 |
1,356 |
$0.00 |
| 90656 |
|
14 |
14 |
$0.00 |
| 90620 |
|
16 |
14 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
1,521 |
1,132 |
$0.00 |
| 90707 |
|
40 |
32 |
$0.00 |
| 3078F |
|
1,464 |
1,089 |
$0.00 |
| 90715 |
|
52 |
42 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
367 |
302 |
$0.00 |
| 90649 |
|
31 |
27 |
$0.00 |
| Z6400 |
|
56 |
56 |
$0.00 |
| D0071 |
|
54 |
51 |
$0.00 |
| D9993 |
|
36 |
35 |
$0.00 |
| 99382 |
|
47 |
40 |
$0.00 |
| D1015 |
|
12 |
12 |
$0.00 |
| 90734 |
|
95 |
74 |
$0.00 |
| 90685 |
|
16 |
15 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
12 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
12 |
$0.00 |