| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
59,503 |
41,658 |
$3.88M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34,206 |
20,074 |
$643K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,071 |
6,548 |
$423K |
| D0330 |
Panoramic radiographic image |
12,144 |
8,521 |
$279K |
| D1351 |
Sealant - per tooth |
12,469 |
3,754 |
$265K |
| D1110 |
Prophylaxis - adult |
10,523 |
8,396 |
$249K |
| D0120 |
Periodic oral evaluation - established patient |
14,346 |
12,560 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,690 |
7,952 |
$185K |
| D1120 |
Prophylaxis - child |
10,246 |
9,544 |
$181K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
10,670 |
6,652 |
$172K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,063 |
3,712 |
$171K |
| D1206 |
Topical application of fluoride varnish |
11,797 |
10,812 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,099 |
16,025 |
$142K |
| D0274 |
Bitewings - four radiographic images |
10,913 |
8,740 |
$139K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,735 |
2,872 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
11,983 |
7,784 |
$128K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
971 |
652 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
24,766 |
19,782 |
$88K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,827 |
2,327 |
$88K |
| D1354 |
|
6,286 |
2,854 |
$86K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,959 |
1,711 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,904 |
1,099 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
4,571 |
2,689 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,646 |
4,836 |
$49K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,357 |
797 |
$45K |
| 90677 |
|
323 |
278 |
$38K |
| D2140 |
|
945 |
589 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,664 |
2,657 |
$27K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,242 |
1,314 |
$26K |
| 96160 |
|
17,963 |
10,592 |
$24K |
| 90686 |
|
3,624 |
2,194 |
$21K |
| 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 |
1,965 |
1,818 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,680 |
1,682 |
$18K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
704 |
387 |
$16K |
| 90651 |
|
334 |
218 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,793 |
1,061 |
$7K |
| 90756 |
|
794 |
499 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,023 |
561 |
$7K |
| 90670 |
|
2,872 |
1,829 |
$6K |
| 90734 |
|
231 |
159 |
$5K |
| 90682 |
|
152 |
99 |
$5K |
| 90698 |
|
2,640 |
1,649 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
103 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,021 |
528 |
$5K |
| 90837 |
Psychotherapy, 53 minutes with patient |
40 |
31 |
$4K |
| 90633 |
|
1,050 |
680 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
77 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
188 |
72 |
$3K |
| D2160 |
|
73 |
37 |
$2K |
| 99188 |
|
927 |
650 |
$2K |
| 90688 |
|
519 |
325 |
$2K |
| 90744 |
|
1,318 |
849 |
$2K |
| 90681 |
|
800 |
499 |
$1K |
| 90715 |
|
233 |
134 |
$1K |
| 99381 |
|
69 |
51 |
$1K |
| D0270 |
|
498 |
281 |
$1K |
| D2332 |
|
25 |
12 |
$689.58 |
| 90732 |
|
21 |
13 |
$685.08 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$520.00 |
| 90672 |
|
211 |
126 |
$492.80 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
57 |
56 |
$479.47 |
| D4910 |
|
14 |
14 |
$443.69 |
| 90707 |
|
83 |
66 |
$426.50 |
| 90716 |
|
83 |
66 |
$416.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
1,318 |
1,231 |
$408.09 |
| 90658 |
|
322 |
225 |
$296.63 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
40 |
30 |
$228.38 |
| 90700 |
|
111 |
76 |
$214.25 |
| 0002A |
|
12 |
12 |
$159.52 |
| 90710 |
|
111 |
65 |
$155.50 |
| 90696 |
|
85 |
50 |
$99.00 |
| 90656 |
|
115 |
113 |
$62.00 |
| 90680 |
|
241 |
138 |
$50.00 |
| 3079F |
|
3,534 |
2,867 |
$14.61 |
| 3077F |
|
939 |
780 |
$13.63 |
| 3080F |
|
899 |
688 |
$12.31 |
| 3074F |
|
7,770 |
6,668 |
$10.19 |
| 3075F |
|
1,982 |
1,736 |
$0.92 |
| 3078F |
|
7,674 |
5,706 |
$0.84 |
| 90685 |
|
143 |
96 |
$0.00 |
| 91300 |
|
57 |
53 |
$0.00 |
| 3008F |
|
13,735 |
8,218 |
$0.00 |
| 90619 |
|
62 |
37 |
$0.00 |
| D9995 |
|
157 |
122 |
$0.00 |
| D0603 |
|
251 |
200 |
$0.00 |
| 91301 |
|
85 |
85 |
$0.00 |