| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
25,537 |
21,157 |
$2.81M |
| 00003 |
Internal/system code - not a standard HCPCS code |
5,717 |
3,125 |
$797K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,133 |
1,064 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
265 |
264 |
$7K |
| 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 |
41 |
40 |
$5K |
| 92551 |
|
661 |
657 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
161 |
160 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
30 |
30 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
39 |
39 |
$1K |
| D1206 |
Topical application of fluoride varnish |
578 |
506 |
$1K |
| D1120 |
Prophylaxis - child |
368 |
327 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
787 |
687 |
$1K |
| 90670 |
|
116 |
116 |
$927.00 |
| 90647 |
|
70 |
70 |
$621.00 |
| D0220 |
Intraoral - periapical first radiographic image |
915 |
780 |
$489.00 |
| 90686 |
|
214 |
213 |
$405.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
41 |
$353.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
82 |
$275.00 |
| 90633 |
|
56 |
56 |
$216.00 |
| D0272 |
Bitewings - two radiographic images |
203 |
175 |
$178.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
57 |
$169.50 |
| 83655 |
|
35 |
35 |
$132.44 |
| 85018 |
|
527 |
524 |
$120.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
677 |
577 |
$119.40 |
| 90723 |
|
13 |
13 |
$117.00 |
| 90734 |
|
12 |
12 |
$108.00 |
| 90649 |
|
12 |
12 |
$108.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
28 |
$90.20 |
| D0274 |
Bitewings - four radiographic images |
155 |
137 |
$79.20 |
| D1110 |
Prophylaxis - adult |
14 |
13 |
$51.00 |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
30 |
$44.00 |
| D0270 |
|
19 |
12 |
$11.50 |
| 3015F |
|
15 |
12 |
$0.00 |
| D9993 |
|
14 |
13 |
$0.00 |
| 99173 |
|
347 |
347 |
$0.00 |
| 99401 |
|
177 |
176 |
$0.00 |
| 3078F |
|
122 |
114 |
$0.00 |
| 90710 |
|
17 |
12 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
117 |
115 |
$0.00 |
| 3725F |
|
42 |
39 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| D9430 |
|
13 |
12 |
$0.00 |
| 3008F |
|
1,612 |
1,543 |
$0.00 |
| D0603 |
|
563 |
506 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
117 |
101 |
$0.00 |
| 3074F |
|
151 |
144 |
$0.00 |
| D1330 |
|
668 |
588 |
$0.00 |
| 97802 |
|
178 |
177 |
$0.00 |
| 90657 |
|
19 |
19 |
$0.00 |
| 99172 |
|
49 |
48 |
$0.00 |
| 1036F |
|
171 |
163 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
176 |
175 |
$0.00 |
| 1126F |
|
170 |
165 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$0.00 |
| 1125F |
|
49 |
44 |
$0.00 |
| 85032 |
|
50 |
50 |
$0.00 |
| D1310 |
|
13 |
12 |
$0.00 |
| D5899 |
|
25 |
13 |
$0.00 |