| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,110 |
12,327 |
$2.31M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,627 |
4,115 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,502 |
1,415 |
$1K |
| 3074F |
|
351 |
317 |
$614.23 |
| 3078F |
|
266 |
247 |
$511.35 |
| 3079F |
|
265 |
242 |
$415.79 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
176 |
174 |
$284.70 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
44 |
43 |
$230.65 |
| 3075F |
|
142 |
134 |
$170.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
708 |
672 |
$167.08 |
| 3044F |
|
26 |
26 |
$70.00 |
| 3077F |
|
27 |
25 |
$70.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
244 |
201 |
$0.00 |
| 3008F |
|
3,600 |
3,233 |
$0.00 |
| 96127 |
|
73 |
68 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
56 |
53 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
576 |
571 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,607 |
1,461 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,446 |
1,437 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
489 |
487 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
81 |
$0.00 |
| D1351 |
Sealant - per tooth |
201 |
38 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
27 |
27 |
$0.00 |
| 90686 |
|
53 |
53 |
$0.00 |
| 85018 |
|
36 |
36 |
$0.00 |
| D1330 |
|
89 |
78 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
157 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
539 |
382 |
$0.00 |
| 90656 |
|
42 |
42 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| 87428 |
|
64 |
63 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
27 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |
| D5899 |
|
21 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,592 |
1,582 |
$0.00 |
| D0330 |
Panoramic radiographic image |
173 |
173 |
$0.00 |
| D0270 |
|
26 |
26 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
188 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
112 |
112 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
13 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
460 |
449 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
801 |
795 |
$0.00 |
| D1120 |
Prophylaxis - child |
274 |
272 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
44 |
44 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
17 |
15 |
$0.00 |
| D2394 |
|
16 |
13 |
$0.00 |