| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,273 |
5,698 |
$871K |
| D0999 |
Unspecified diagnostic procedure, by report |
5,513 |
4,080 |
$641K |
| D1120 |
Prophylaxis - child |
1,996 |
1,580 |
$0.00 |
| 81002 |
|
463 |
383 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
876 |
729 |
$0.00 |
| D1110 |
Prophylaxis - adult |
152 |
120 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
751 |
613 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
140 |
93 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
63 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
43 |
41 |
$0.00 |
| 81025 |
|
166 |
153 |
$0.00 |
| 90649 |
|
13 |
13 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
177 |
88 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
127 |
79 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
366 |
295 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
44 |
44 |
$0.00 |
| 0502F |
|
16 |
14 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
16 |
16 |
$0.00 |
| 96160 |
|
13 |
13 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,968 |
2,512 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
935 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,955 |
1,545 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,350 |
1,227 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
223 |
193 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
213 |
174 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
322 |
217 |
$0.00 |
| D0603 |
|
877 |
657 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,618 |
1,321 |
$0.00 |
| 90686 |
|
14 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
323 |
279 |
$0.00 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
46 |
32 |
$0.00 |
| 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 |
41 |
25 |
$0.00 |
| D1351 |
Sealant - per tooth |
33 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
108 |
89 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
28 |
28 |
$0.00 |
| 92551 |
|
17 |
16 |
$0.00 |