| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
50,264 |
31,335 |
$6.08M |
| D0999 |
Unspecified diagnostic procedure, by report |
41,195 |
36,429 |
$4.69M |
| 90734 |
|
914 |
599 |
$6K |
| 90670 |
|
4,134 |
2,509 |
$5K |
| 90651 |
|
1,198 |
787 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
14,262 |
13,951 |
$3K |
| 90686 |
|
3,669 |
2,660 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,069 |
5,937 |
$2K |
| 90710 |
|
425 |
302 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,863 |
10,320 |
$2K |
| D1120 |
Prophylaxis - child |
14,900 |
14,563 |
$2K |
| 90633 |
|
2,099 |
1,325 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
3,492 |
3,369 |
$1K |
| 90715 |
|
498 |
310 |
$1K |
| 90716 |
|
1,000 |
547 |
$1K |
| D2140 |
|
1,519 |
1,374 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,881 |
2,486 |
$1K |
| D1206 |
Topical application of fluoride varnish |
14,579 |
14,246 |
$851.66 |
| 90723 |
|
3,172 |
1,957 |
$773.05 |
| 90647 |
|
3,117 |
1,930 |
$548.00 |
| D1110 |
Prophylaxis - adult |
1,476 |
1,436 |
$483.06 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,639 |
6,052 |
$429.80 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,223 |
1,897 |
$364.85 |
| 90681 |
|
1,964 |
1,229 |
$345.35 |
| 90707 |
|
935 |
492 |
$318.88 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,503 |
2,370 |
$311.48 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,688 |
3,187 |
$278.08 |
| D0210 |
Intraoral - complete series of radiographic images |
2,165 |
2,140 |
$240.80 |
| 81002 |
|
9,747 |
5,552 |
$239.06 |
| 96127 |
|
6,642 |
5,402 |
$233.60 |
| 90700 |
|
685 |
427 |
$203.00 |
| D0274 |
Bitewings - four radiographic images |
7,073 |
6,888 |
$202.80 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
767 |
694 |
$168.17 |
| D7140 |
Extraction, erupted tooth or exposed root |
803 |
720 |
$156.48 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,197 |
1,090 |
$150.87 |
| D0220 |
Intraoral - periapical first radiographic image |
11,714 |
11,373 |
$123.20 |
| 99381 |
|
763 |
680 |
$91.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,329 |
8,761 |
$87.40 |
| 90696 |
|
378 |
264 |
$65.93 |
| 81025 |
|
305 |
253 |
$64.50 |
| 90685 |
|
35 |
35 |
$63.60 |
| 59430 |
|
346 |
276 |
$50.15 |
| D0330 |
Panoramic radiographic image |
861 |
834 |
$45.20 |
| 99173 |
|
176 |
128 |
$22.35 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
655 |
490 |
$15.70 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,891 |
5,114 |
$0.00 |
| D0602 |
|
1,109 |
1,081 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,994 |
1,105 |
$0.00 |
| D0601 |
|
280 |
280 |
$0.00 |
| D1351 |
Sealant - per tooth |
4,830 |
3,256 |
$0.00 |
| D0603 |
|
2,508 |
2,455 |
$0.00 |
| D2160 |
|
256 |
235 |
$0.00 |
| 90474 |
|
1,362 |
762 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
5,724 |
4,143 |
$0.00 |
| 88720 |
|
30 |
26 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
389 |
382 |
$0.00 |
| 97802 |
|
1,794 |
1,416 |
$0.00 |
| D4355 |
|
318 |
274 |
$0.00 |
| 90656 |
|
40 |
40 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
44 |
44 |
$0.00 |
| 99383 |
|
26 |
25 |
$0.00 |
| 99024 |
|
30 |
27 |
$0.00 |
| 99384 |
|
27 |
25 |
$0.00 |
| D2331 |
|
12 |
12 |
$0.00 |
| 0502F |
|
3,219 |
2,407 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
8,943 |
3,324 |
$0.00 |
| 97803 |
|
3,920 |
2,777 |
$0.00 |
| 59425 |
|
881 |
624 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,499 |
1,124 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,708 |
1,289 |
$0.00 |
| 59426 |
|
4,437 |
1,796 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
114 |
110 |
$0.00 |
| D0270 |
|
38 |
38 |
$0.00 |
| D1354 |
|
91 |
89 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
123 |
119 |
$0.00 |
| 99201 |
|
82 |
81 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
226 |
210 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
13 |
$0.00 |