| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,357 |
5,601 |
$2.09M |
| D0120 |
Periodic oral evaluation - established patient |
5,389 |
5,085 |
$241K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,510 |
3,248 |
$187K |
| D0140 |
Limited oral evaluation - problem focused |
2,962 |
2,755 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,642 |
1,332 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,397 |
1,122 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
3,359 |
3,117 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,924 |
2,796 |
$52K |
| D1110 |
Prophylaxis - adult |
1,396 |
1,282 |
$46K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,910 |
2,513 |
$39K |
| H1000 |
Prenatal care, at-risk assessment |
2,259 |
2,258 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
641 |
476 |
$30K |
| D1120 |
Prophylaxis - child |
3,744 |
3,563 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,905 |
1,785 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
817 |
776 |
$24K |
| 96127 |
|
1,148 |
1,143 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,467 |
1,405 |
$15K |
| 90670 |
|
1,297 |
1,219 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,056 |
1,023 |
$10K |
| D1351 |
Sealant - per tooth |
486 |
364 |
$9K |
| 90651 |
|
658 |
613 |
$9K |
| 90686 |
|
1,256 |
1,151 |
$8K |
| 90698 |
|
1,169 |
1,109 |
$8K |
| 90734 |
|
621 |
580 |
$7K |
| 86580 |
|
1,237 |
1,178 |
$5K |
| 90633 |
|
809 |
768 |
$5K |
| 90680 |
|
698 |
660 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
875 |
771 |
$5K |
| 90744 |
|
686 |
652 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,791 |
1,565 |
$4K |
| 90710 |
|
346 |
326 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
911 |
854 |
$4K |
| 90685 |
|
718 |
659 |
$4K |
| 90620 |
|
393 |
362 |
$4K |
| 90715 |
|
397 |
376 |
$3K |
| 90716 |
|
401 |
378 |
$3K |
| 90696 |
|
331 |
311 |
$2K |
| 90707 |
|
380 |
357 |
$2K |
| D0330 |
Panoramic radiographic image |
383 |
342 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
161 |
149 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
433 |
294 |
$972.35 |
| 90832 |
Psychotherapy, 30 minutes with patient |
400 |
278 |
$780.25 |
| 90791 |
Psychiatric diagnostic evaluation |
105 |
89 |
$740.89 |
| 81025 |
|
246 |
170 |
$229.62 |
| 92227 |
|
16 |
12 |
$105.44 |
| 81002 |
|
468 |
328 |
$103.93 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
91 |
88 |
$64.30 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
330 |
321 |
$49.25 |
| 90700 |
|
49 |
45 |
$44.80 |
| 90648 |
|
43 |
40 |
$44.63 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
175 |
166 |
$32.15 |
| 87210 |
|
18 |
12 |
$18.80 |
| 82962 |
|
66 |
52 |
$3.36 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
74 |
70 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
203 |
104 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
237 |
227 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
124 |
116 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
13 |
13 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
71 |
58 |
$0.00 |
| D0270 |
|
79 |
79 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$0.00 |
| 0502F |
|
278 |
183 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
172 |
108 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
13 |
13 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
125 |
101 |
$0.00 |
| 59430 |
|
16 |
15 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
262 |
188 |
$0.00 |
| D1330 |
|
151 |
116 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
16 |
$0.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
19 |
14 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
49 |
34 |
$0.00 |
| 94760 |
|
25 |
19 |
$0.00 |