| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,725 |
13,970 |
$4.55M |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,448 |
676 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
491 |
403 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
650 |
521 |
$14K |
| 83655 |
|
990 |
961 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
988 |
961 |
$12K |
| D1110 |
Prophylaxis - adult |
3,113 |
2,977 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,098 |
775 |
$7K |
| D0330 |
Panoramic radiographic image |
1,728 |
1,580 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
121 |
115 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
1,217 |
1,212 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
202 |
201 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
4,390 |
3,907 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,704 |
1,616 |
$3K |
| D4355 |
|
277 |
248 |
$3K |
| 36416 |
|
982 |
956 |
$3K |
| D0274 |
Bitewings - four radiographic images |
2,096 |
1,916 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,174 |
615 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
160 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
4,516 |
4,014 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,241 |
1,200 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
291 |
241 |
$1K |
| D9110 |
|
299 |
274 |
$966.40 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
26 |
24 |
$769.06 |
| 99205 |
Prolong outpt/office vis |
18 |
17 |
$732.05 |
| 90791 |
Psychiatric diagnostic evaluation |
49 |
31 |
$623.20 |
| D1206 |
Topical application of fluoride varnish |
3,568 |
3,163 |
$519.38 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25 |
25 |
$445.06 |
| 90837 |
Psychotherapy, 53 minutes with patient |
22 |
12 |
$113.43 |
| 3008F |
|
25 |
25 |
$90.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
939 |
591 |
$77.14 |
| 36415 |
Collection of venous blood by venipuncture |
193 |
167 |
$36.38 |
| D4910 |
|
265 |
224 |
$0.00 |
| D0191 |
|
1,716 |
1,464 |
$0.00 |
| D0270 |
|
47 |
38 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
44 |
$0.00 |
| D1354 |
|
158 |
14 |
$0.00 |
| D9215 |
|
2,055 |
1,652 |
$0.00 |
| D0603 |
|
1,548 |
1,327 |
$0.00 |
| D1310 |
|
1,136 |
972 |
$0.00 |
| D1320 |
|
1,136 |
972 |
$0.00 |
| D2330 |
|
24 |
12 |
$0.00 |
| D1330 |
|
2,848 |
2,395 |
$0.00 |
| D9210 |
|
61 |
51 |
$0.00 |