| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
50,245 |
46,036 |
$3.58M |
| D1120 |
Prophylaxis - child |
18,656 |
17,334 |
$421K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,011 |
17,643 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
19,873 |
18,657 |
$168K |
| D1351 |
Sealant - per tooth |
9,529 |
3,763 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75,151 |
17,380 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,024 |
4,326 |
$130K |
| D0274 |
Bitewings - four radiographic images |
12,917 |
12,159 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
20,623 |
18,643 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,167 |
2,830 |
$68K |
| D1310 |
|
19,477 |
17,977 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,284 |
1,233 |
$28K |
| 00003 |
Internal/system code - not a standard HCPCS code |
158 |
147 |
$27K |
| D0170 |
|
890 |
767 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,919 |
1,792 |
$23K |
| D9999 |
Unspecified adjunctive procedure, by report |
246 |
222 |
$21K |
| D9430 |
|
1,225 |
1,177 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,655 |
2,571 |
$7K |
| D0603 |
|
3,869 |
3,845 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,628 |
4,967 |
$6K |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
180 |
160 |
$4K |
| D0272 |
Bitewings - two radiographic images |
840 |
789 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
59 |
59 |
$4K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
222 |
156 |
$3K |
| 99215 |
Prolong outpt/office vis |
1,381 |
1,200 |
$1K |
| D0270 |
|
378 |
370 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
28 |
$1K |
| 0502F |
|
519 |
288 |
$872.11 |
| D1999 |
|
12 |
12 |
$720.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
67 |
$700.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
25 |
$492.00 |
| D1352 |
|
85 |
68 |
$418.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,453 |
2,053 |
$312.21 |
| 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 |
53 |
51 |
$157.04 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
269 |
229 |
$137.80 |
| 59425 |
|
13 |
12 |
$60.48 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
102 |
86 |
$34.30 |
| D1320 |
|
258 |
200 |
$22.50 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$17.08 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
6,881 |
5,706 |
$0.00 |
| 3075F |
|
748 |
602 |
$0.00 |
| 3008F |
|
7,014 |
5,817 |
$0.00 |
| D1330 |
|
16,955 |
15,712 |
$0.00 |
| 2001F |
|
7,019 |
5,820 |
$0.00 |
| 1036F |
|
5,680 |
4,659 |
$0.00 |
| 3049F |
|
908 |
777 |
$0.00 |
| 3048F |
|
1,237 |
1,029 |
$0.00 |
| 3074F |
|
5,020 |
4,193 |
$0.00 |
| Z1034 |
|
297 |
182 |
$0.00 |
| 3079F |
|
1,777 |
1,474 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
279 |
221 |
$0.00 |
| 92551 |
|
319 |
306 |
$0.00 |
| 90688 |
|
46 |
40 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
135 |
121 |
$0.00 |
| 99383 |
|
17 |
13 |
$0.00 |
| D4999 |
|
84 |
84 |
$0.00 |
| 3080F |
|
206 |
158 |
$0.00 |
| D9995 |
|
705 |
686 |
$0.00 |
| 90674 |
|
99 |
97 |
$0.00 |
| 1034F |
|
54 |
52 |
$0.00 |
| 99384 |
|
14 |
13 |
$0.00 |
| 3077F |
|
1,073 |
913 |
$0.00 |
| 3078F |
|
4,699 |
3,954 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
1,073 |
913 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
6,197 |
5,130 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
34 |
34 |
$0.00 |
| 3050F |
|
609 |
498 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
95 |
92 |
$0.00 |
| 99173 |
|
324 |
310 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
153 |
149 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
59 |
57 |
$0.00 |
| 99201 |
|
14 |
14 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$0.00 |
| 4004F |
|
14 |
12 |
$0.00 |