| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
13,793 |
8,154 |
$1.52M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,239 |
6,706 |
$1.15M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,940 |
5,578 |
$930K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,155 |
1,400 |
$41K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
226 |
222 |
$39K |
| D1999 |
|
4,137 |
3,778 |
$39K |
| 90686 |
|
1,729 |
1,709 |
$21K |
| D1206 |
Topical application of fluoride varnish |
2,050 |
1,663 |
$17K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
268 |
266 |
$14K |
| 36415 |
Collection of venous blood by venipuncture |
3,002 |
2,877 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
264 |
262 |
$12K |
| H0046 |
Mental health services, not otherwise specified |
184 |
158 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
2,652 |
2,633 |
$11K |
| D1120 |
Prophylaxis - child |
876 |
872 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
96 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
979 |
977 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
92 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
167 |
$7K |
| 0002A |
|
162 |
162 |
$7K |
| 90832 |
Psychotherapy, 30 minutes with patient |
244 |
145 |
$7K |
| D1351 |
Sealant - per tooth |
340 |
102 |
$6K |
| 0001A |
|
118 |
118 |
$6K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
768 |
747 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
480 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25 |
25 |
$4K |
| 83655 |
|
378 |
374 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,737 |
2,708 |
$3K |
| 90651 |
|
142 |
140 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
209 |
209 |
$2K |
| D1110 |
Prophylaxis - adult |
146 |
146 |
$2K |
| D0274 |
Bitewings - four radiographic images |
415 |
414 |
$2K |
| D0330 |
Panoramic radiographic image |
857 |
855 |
$2K |
| D0270 |
|
1,570 |
1,560 |
$2K |
| 90670 |
|
109 |
108 |
$1K |
| 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 |
47 |
42 |
$1K |
| 99173 |
|
614 |
609 |
$1K |
| 85018 |
|
524 |
519 |
$1K |
| 99177 |
|
89 |
88 |
$1K |
| 90480 |
|
31 |
27 |
$1K |
| 0004A |
|
29 |
29 |
$1K |
| 90656 |
|
76 |
73 |
$773.42 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
60 |
56 |
$642.66 |
| 0124A |
|
17 |
17 |
$627.98 |
| 0072A |
|
15 |
15 |
$558.75 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
32 |
31 |
$512.07 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
25 |
$429.86 |
| 90723 |
|
39 |
39 |
$423.36 |
| 90734 |
|
30 |
30 |
$327.60 |
| 90674 |
|
14 |
14 |
$312.65 |
| 90633 |
|
25 |
25 |
$273.00 |
| D0272 |
Bitewings - two radiographic images |
167 |
163 |
$195.00 |
| 90619 |
|
14 |
14 |
$152.88 |
| 90716 |
|
14 |
12 |
$131.04 |
| 90647 |
|
12 |
12 |
$128.52 |
| 90707 |
|
14 |
12 |
$120.12 |
| 82270 |
|
13 |
13 |
$52.56 |
| D0230 |
Intraoral - periapical each additional radiographic image |
260 |
111 |
$0.00 |
| 36416 |
|
12 |
12 |
$0.00 |