| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
14,891 |
12,066 |
$6.29M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,703 |
2,239 |
$148K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,828 |
1,511 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,366 |
1,332 |
$33K |
| D1206 |
Topical application of fluoride varnish |
830 |
803 |
$12K |
| D1120 |
Prophylaxis - child |
462 |
446 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
235 |
205 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
547 |
500 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
176 |
$5K |
| D0274 |
Bitewings - four radiographic images |
206 |
202 |
$3K |
| D1110 |
Prophylaxis - adult |
54 |
52 |
$2K |
| 0012A |
|
86 |
86 |
$2K |
| 0011A |
|
92 |
92 |
$1K |
| 0002A |
|
30 |
29 |
$1K |
| 0001A |
|
26 |
25 |
$1K |
| 0064A |
|
27 |
27 |
$1K |
| 90688 |
|
78 |
76 |
$824.47 |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
65 |
$821.50 |
| 0071A |
|
19 |
19 |
$720.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
105 |
$537.48 |
| 0072A |
|
14 |
14 |
$520.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
29 |
27 |
$331.32 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
27 |
$175.62 |
| 90686 |
|
20 |
20 |
$164.79 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
17 |
14 |
$133.41 |
| 36415 |
Collection of venous blood by venipuncture |
39 |
37 |
$101.77 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
30 |
29 |
$0.00 |
| 91307 |
|
52 |
49 |
$0.00 |
| 91301 |
|
195 |
194 |
$0.00 |
| 91306 |
|
26 |
26 |
$0.00 |
| 91300 |
|
79 |
73 |
$0.00 |