| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,656 |
10,293 |
$881K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,353 |
2,235 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,052 |
1,109 |
$85K |
| D0330 |
Panoramic radiographic image |
3,107 |
1,820 |
$55K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,457 |
904 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
3,035 |
1,779 |
$30K |
| 90834 |
Psychotherapy, 45 minutes with patient |
893 |
218 |
$27K |
| D1110 |
Prophylaxis - adult |
1,585 |
942 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
668 |
356 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,121 |
1,266 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
622 |
298 |
$18K |
| D1206 |
Topical application of fluoride varnish |
2,226 |
1,272 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,659 |
957 |
$12K |
| D1120 |
Prophylaxis - child |
1,583 |
894 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
4,182 |
2,484 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
612 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,066 |
1,309 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
412 |
245 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
236 |
114 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
124 |
49 |
$5K |
| 92015 |
Determination of refractive state |
755 |
466 |
$3K |
| D1351 |
Sealant - per tooth |
364 |
69 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
356 |
204 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
146 |
78 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
217 |
120 |
$2K |
| D0272 |
Bitewings - two radiographic images |
330 |
197 |
$2K |
| 90837 |
Psychotherapy, 53 minutes with patient |
55 |
14 |
$1K |
| D0270 |
|
518 |
307 |
$1K |
| 99173 |
|
131 |
67 |
$146.52 |
| 86403 |
|
28 |
24 |
$132.52 |
| 81002 |
|
67 |
52 |
$78.18 |
| 90686 |
|
53 |
28 |
$39.16 |
| 3074F |
|
511 |
264 |
$0.01 |
| 3078F |
|
168 |
82 |
$0.00 |
| 1159F |
|
216 |
187 |
$0.00 |
| 1160F |
|
214 |
186 |
$0.00 |
| D1999 |
|
679 |
453 |
$0.00 |
| 90734 |
|
21 |
12 |
$0.00 |
| D0603 |
|
299 |
220 |
$0.00 |
| 1036F |
|
47 |
32 |
$0.00 |
| G8419 |
Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
158 |
76 |
$0.00 |
| 3079F |
|
68 |
42 |
$0.00 |