| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,499 |
6,772 |
$1.55M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29,975 |
27,351 |
$513K |
| D0120 |
Periodic oral evaluation - established patient |
2,543 |
2,346 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,348 |
4,303 |
$66K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,039 |
3,983 |
$66K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,873 |
5,732 |
$63K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,635 |
1,604 |
$58K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,571 |
1,536 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
3,653 |
3,586 |
$56K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,381 |
1,367 |
$50K |
| D1110 |
Prophylaxis - adult |
2,320 |
2,303 |
$38K |
| 90677 |
|
230 |
220 |
$36K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,394 |
1,324 |
$33K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
868 |
856 |
$33K |
| D0330 |
Panoramic radiographic image |
3,662 |
3,609 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
970 |
968 |
$27K |
| D1120 |
Prophylaxis - child |
1,469 |
1,453 |
$27K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,817 |
2,797 |
$27K |
| 90697 |
|
276 |
263 |
$23K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,079 |
2,010 |
$22K |
| D0274 |
Bitewings - four radiographic images |
2,733 |
2,695 |
$12K |
| 90651 |
|
425 |
415 |
$10K |
| 90619 |
|
67 |
67 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
3,486 |
3,380 |
$8K |
| 59426 |
|
206 |
139 |
$7K |
| 90686 |
|
1,963 |
1,926 |
$6K |
| D1206 |
Topical application of fluoride varnish |
633 |
627 |
$5K |
| 90474 |
|
485 |
478 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,881 |
2,386 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
122 |
114 |
$3K |
| 90670 |
|
502 |
489 |
$3K |
| 59425 |
|
318 |
279 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
49 |
$2K |
| 90734 |
|
163 |
163 |
$2K |
| 90381 |
|
13 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
222 |
217 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
41 |
41 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
61 |
60 |
$1K |
| 99201 |
|
42 |
42 |
$1K |
| 90461 |
|
131 |
130 |
$1K |
| 90633 |
|
456 |
440 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
76 |
73 |
$1K |
| 81000 |
|
2,341 |
1,789 |
$1K |
| 99173 |
|
2,726 |
2,694 |
$1K |
| 90656 |
|
276 |
276 |
$879.01 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
98 |
98 |
$693.71 |
| 92551 |
|
265 |
265 |
$640.38 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
68 |
66 |
$559.74 |
| 99383 |
|
77 |
77 |
$379.35 |
| 90680 |
|
280 |
265 |
$269.72 |
| 90480 |
|
14 |
14 |
$204.72 |
| D0171 |
|
14 |
13 |
$180.00 |
| 90715 |
|
96 |
95 |
$127.54 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
12 |
12 |
$97.26 |
| 3074F |
|
13,262 |
11,751 |
$76.00 |
| 82947 |
|
211 |
208 |
$72.00 |
| 3078F |
|
12,466 |
11,116 |
$63.00 |
| 85018 |
|
87 |
87 |
$25.00 |
| 3080F |
|
686 |
631 |
$3.00 |
| 3079F |
|
1,807 |
1,679 |
$3.00 |
| 3077F |
|
1,009 |
925 |
$2.00 |
| 94760 |
|
158 |
146 |
$1.32 |
| 3075F |
|
1,088 |
1,038 |
$1.00 |
| 90716 |
|
31 |
29 |
$0.00 |
| 1127F |
|
16 |
16 |
$0.00 |
| 99381 |
|
25 |
25 |
$0.00 |
| 0502F |
|
1,384 |
988 |
$0.00 |
| 91300 |
|
26 |
25 |
$0.00 |
| D1999 |
|
55 |
51 |
$0.00 |
| 87806 |
|
94 |
94 |
$0.00 |
| D9990 |
|
13 |
12 |
$0.00 |
| 82274 |
|
12 |
12 |
$0.00 |
| D5986 |
|
120 |
119 |
$0.00 |
| 90648 |
|
26 |
26 |
$0.00 |