| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,136 |
15,116 |
$3.42M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,077 |
10,253 |
$652K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,597 |
4,297 |
$261K |
| D0140 |
Limited oral evaluation - problem focused |
2,924 |
2,736 |
$72K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,650 |
1,183 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,950 |
1,919 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,440 |
467 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,724 |
2,547 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
628 |
516 |
$42K |
| 80305 |
|
3,679 |
3,223 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
1,064 |
1,044 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,176 |
2,902 |
$28K |
| 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 |
2,886 |
2,389 |
$28K |
| D1110 |
Prophylaxis - adult |
629 |
617 |
$27K |
| 90791 |
Psychiatric diagnostic evaluation |
263 |
246 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
712 |
700 |
$24K |
| D0330 |
Panoramic radiographic image |
1,473 |
1,436 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
577 |
554 |
$18K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
572 |
545 |
$15K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
134 |
132 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
151 |
$12K |
| D4910 |
|
219 |
210 |
$8K |
| D0274 |
Bitewings - four radiographic images |
573 |
567 |
$8K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
622 |
598 |
$7K |
| D4341 |
|
253 |
193 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
52 |
$7K |
| D1999 |
|
425 |
365 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,063 |
554 |
$4K |
| D1354 |
|
853 |
181 |
$2K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
79 |
64 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
26 |
$1K |
| D1351 |
Sealant - per tooth |
62 |
25 |
$791.28 |
| 90688 |
|
30 |
30 |
$538.21 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
15 |
$123.00 |
| D0270 |
|
25 |
24 |
$115.92 |
| 3078F |
|
85 |
85 |
$0.00 |
| D0431 |
|
14 |
12 |
$0.00 |
| 3074F |
|
133 |
132 |
$0.00 |
| D1330 |
|
51 |
51 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
13 |
12 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D1320 |
|
13 |
13 |
$0.00 |
| 3079F |
|
12 |
12 |
$0.00 |