| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
9,874 |
8,441 |
$990K |
| T1015 |
Clinic visit/encounter, all-inclusive |
7,468 |
3,979 |
$707K |
| 0124A |
|
240 |
233 |
$10K |
| 0011A |
|
167 |
154 |
$7K |
| 0012A |
|
134 |
124 |
$5K |
| 0004A |
|
104 |
96 |
$4K |
| 0064A |
|
103 |
102 |
$4K |
| 0002A |
|
71 |
71 |
$3K |
| 0001A |
|
71 |
71 |
$3K |
| D1120 |
Prophylaxis - child |
4,658 |
4,338 |
$2K |
| 0071A |
|
50 |
50 |
$2K |
| 0072A |
|
42 |
42 |
$2K |
| 90686 |
|
386 |
318 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,804 |
1,649 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
54 |
40 |
$1K |
| D1351 |
Sealant - per tooth |
1,985 |
801 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
349 |
$1K |
| 90480 |
|
60 |
60 |
$931.50 |
| D1206 |
Topical application of fluoride varnish |
3,409 |
3,129 |
$910.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,825 |
3,553 |
$756.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
317 |
181 |
$703.72 |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
213 |
$625.92 |
| D0210 |
Intraoral - complete series of radiographic images |
143 |
121 |
$511.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
720 |
685 |
$442.00 |
| D0274 |
Bitewings - four radiographic images |
1,260 |
1,141 |
$283.50 |
| 81025 |
|
548 |
348 |
$187.64 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
204 |
$154.25 |
| D0272 |
Bitewings - two radiographic images |
1,456 |
1,340 |
$112.80 |
| D0220 |
Intraoral - periapical first radiographic image |
3,089 |
2,694 |
$70.23 |
| D0140 |
Limited oral evaluation - problem focused |
424 |
375 |
$48.60 |
| 90734 |
|
35 |
26 |
$12.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,503 |
1,250 |
$3.80 |
| 82962 |
|
177 |
55 |
$1.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
654 |
465 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
894 |
591 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
218 |
102 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
501 |
338 |
$0.00 |
| 0502F |
|
235 |
120 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
330 |
206 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
25 |
24 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
160 |
99 |
$0.00 |
| H0050 |
Alcohol and/or drug services, brief intervention, per 15 minutes |
913 |
305 |
$0.00 |
| D9110 |
|
148 |
144 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
203 |
105 |
$0.00 |
| 90715 |
|
23 |
13 |
$0.00 |
| 81002 |
|
167 |
74 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
40 |
29 |
$0.00 |
| D0270 |
|
64 |
50 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,810 |
979 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,268 |
945 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
156 |
108 |
$0.00 |
| 36416 |
|
391 |
127 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,845 |
1,651 |
$0.00 |
| 3008F |
|
1,960 |
1,235 |
$0.00 |
| 96127 |
|
2,872 |
1,244 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
454 |
316 |
$0.00 |
| 90651 |
|
25 |
18 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
31 |
30 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
217 |
100 |
$0.00 |
| 2015F |
|
119 |
61 |
$0.00 |
| 94200 |
|
141 |
46 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
71 |
16 |
$0.00 |