| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,807 |
27,021 |
$8.86M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,522 |
1,305 |
$65K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,815 |
1,349 |
$65K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,920 |
1,646 |
$39K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,731 |
1,099 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,501 |
2,582 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,293 |
1,077 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
2,412 |
2,331 |
$14K |
| D1206 |
Topical application of fluoride varnish |
10,422 |
10,092 |
$12K |
| D1110 |
Prophylaxis - adult |
5,848 |
5,668 |
$11K |
| D1351 |
Sealant - per tooth |
5,218 |
1,295 |
$10K |
| D1120 |
Prophylaxis - child |
3,944 |
3,834 |
$9K |
| D0274 |
Bitewings - four radiographic images |
4,917 |
4,792 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,543 |
2,448 |
$7K |
| D0191 |
|
4,508 |
4,388 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
5,199 |
5,067 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
4,811 |
4,589 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,029 |
770 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
9,147 |
8,793 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,963 |
5,567 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
434 |
368 |
$3K |
| 99000 |
|
1,112 |
917 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
37 |
$3K |
| 98940 |
|
2,526 |
928 |
$2K |
| D4355 |
|
196 |
187 |
$2K |
| D2331 |
|
87 |
62 |
$1K |
| 99443 |
|
91 |
42 |
$1K |
| 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 |
35 |
26 |
$875.25 |
| 90686 |
|
29 |
27 |
$435.82 |
| 36415 |
Collection of venous blood by venipuncture |
898 |
792 |
$343.16 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
25 |
$175.95 |
| 3008F |
|
166 |
135 |
$80.00 |
| D5899 |
|
1,005 |
521 |
$0.00 |
| 3074F |
|
115 |
99 |
$0.00 |
| 3079F |
|
36 |
31 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
21 |
18 |
$0.00 |
| 3080F |
|
16 |
13 |
$0.00 |
| D2330 |
|
32 |
25 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
17 |
16 |
$0.00 |
| D0330 |
Panoramic radiographic image |
390 |
382 |
$0.00 |
| D0270 |
|
230 |
218 |
$0.00 |
| 3078F |
|
80 |
69 |
$0.00 |