| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
51,608 |
49,236 |
$12.12M |
| D0120 |
Periodic oral evaluation - established patient |
20,548 |
20,409 |
$594K |
| D1206 |
Topical application of fluoride varnish |
19,069 |
18,923 |
$357K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,519 |
3,849 |
$336K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,500 |
4,547 |
$316K |
| D1110 |
Prophylaxis - adult |
4,499 |
4,454 |
$216K |
| D1120 |
Prophylaxis - child |
9,091 |
9,050 |
$215K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,428 |
5,224 |
$142K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,391 |
4,078 |
$140K |
| D0274 |
Bitewings - four radiographic images |
12,332 |
12,215 |
$133K |
| D0330 |
Panoramic radiographic image |
2,868 |
2,831 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
11,242 |
11,082 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,578 |
2,546 |
$99K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,449 |
1,382 |
$62K |
| D1351 |
Sealant - per tooth |
2,721 |
1,128 |
$58K |
| D4341 |
|
1,426 |
1,018 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,531 |
7,394 |
$51K |
| D0272 |
Bitewings - two radiographic images |
5,649 |
5,615 |
$43K |
| D1999 |
|
3,142 |
2,981 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
710 |
418 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,541 |
1,496 |
$37K |
| 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 |
2,988 |
2,659 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
89 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
85 |
$7K |
| D2331 |
|
72 |
54 |
$6K |
| 0003A |
|
116 |
115 |
$4K |
| D2140 |
|
69 |
63 |
$3K |
| 0124A |
|
78 |
77 |
$3K |
| 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 |
198 |
117 |
$3K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
205 |
159 |
$2K |
| D4910 |
|
25 |
25 |
$2K |
| 90686 |
|
146 |
145 |
$2K |
| 0072A |
|
41 |
40 |
$2K |
| 0071A |
|
38 |
38 |
$1K |
| D9992 |
|
84 |
83 |
$1K |
| D4342 |
|
39 |
24 |
$929.81 |
| 0002A |
|
12 |
12 |
$480.00 |
| 0031A |
|
12 |
12 |
$480.00 |
| 0001A |
|
12 |
12 |
$480.00 |
| D2330 |
|
14 |
13 |
$469.75 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
51 |
50 |
$430.65 |
| D0270 |
|
82 |
68 |
$255.84 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
25 |
25 |
$9.70 |
| 91300 |
|
191 |
185 |
$0.00 |
| 3078F |
|
1,058 |
1,000 |
$0.00 |
| 3077F |
|
13 |
13 |
$0.00 |
| 91312 |
|
78 |
77 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
14 |
13 |
$0.00 |
| 3074F |
|
1,206 |
1,144 |
$0.00 |
| D0603 |
|
4,706 |
4,681 |
$0.00 |
| 3079F |
|
119 |
112 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
66 |
66 |
$0.00 |
| 91307 |
|
95 |
91 |
$0.00 |
| 91305 |
|
27 |
27 |
$0.00 |