| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,584 |
1,668 |
$187K |
| D1120 |
Prophylaxis - child |
1,793 |
1,792 |
$63K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
296 |
294 |
$51K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
238 |
234 |
$44K |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
425 |
397 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,903 |
1,903 |
$32K |
| D1351 |
Sealant - per tooth |
697 |
229 |
$21K |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
114 |
101 |
$7K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
590 |
561 |
$5K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$2K |
| 99442 |
|
76 |
73 |
$2K |
| 85018 |
|
564 |
535 |
$1K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
18 |
13 |
$809.65 |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
56 |
$756.97 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$479.20 |