| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,280 |
12,855 |
$5.04M |
| D0140 |
Limited oral evaluation - problem focused |
8,011 |
7,596 |
$195K |
| D9630 |
|
2,125 |
1,954 |
$84K |
| D1206 |
Topical application of fluoride varnish |
3,306 |
3,104 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,734 |
1,626 |
$54K |
| D1120 |
Prophylaxis - child |
3,956 |
3,672 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
432 |
319 |
$32K |
| D9110 |
|
471 |
413 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
476 |
297 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
594 |
546 |
$27K |
| D1110 |
Prophylaxis - adult |
596 |
559 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,886 |
1,693 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
132 |
$14K |
| 90832 |
Psychotherapy, 30 minutes with patient |
265 |
252 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
294 |
261 |
$12K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
123 |
121 |
$11K |
| D4341 |
|
246 |
90 |
$11K |
| D0274 |
Bitewings - four radiographic images |
916 |
850 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
183 |
180 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
60 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
132 |
$6K |
| D4346 |
|
217 |
194 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,898 |
889 |
$4K |
| D0272 |
Bitewings - two radiographic images |
212 |
189 |
$2K |
| D4342 |
|
41 |
13 |
$980.07 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
12 |
$258.18 |
| D0191 |
|
322 |
319 |
$0.00 |
| D0180 |
|
61 |
59 |
$0.00 |
| D1330 |
|
433 |
433 |
$0.00 |