| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
16,954 |
12,877 |
$1.34M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,278 |
7,659 |
$253K |
| D1351 |
Sealant - per tooth |
20,638 |
3,485 |
$195K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,787 |
2,252 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,110 |
7,854 |
$91K |
| D1120 |
Prophylaxis - child |
4,987 |
4,845 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
5,128 |
4,998 |
$82K |
| D0330 |
Panoramic radiographic image |
1,877 |
1,767 |
$73K |
| D1354 |
|
5,439 |
1,658 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,186 |
2,107 |
$55K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
467 |
299 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
790 |
510 |
$45K |
| D1110 |
Prophylaxis - adult |
1,378 |
1,354 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,923 |
2,800 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,350 |
2,325 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,141 |
700 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
900 |
832 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,747 |
2,256 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
3,384 |
3,221 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
211 |
151 |
$11K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,415 |
847 |
$8K |
| 90791 |
Psychiatric diagnostic evaluation |
157 |
91 |
$7K |
| 96160 |
|
5,297 |
3,125 |
$7K |
| 90832 |
Psychotherapy, 30 minutes with patient |
404 |
181 |
$6K |
| 99215 |
Prolong outpt/office vis |
108 |
80 |
$5K |
| D2140 |
|
135 |
110 |
$5K |
| D1206 |
Topical application of fluoride varnish |
359 |
355 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
203 |
110 |
$5K |
| 90677 |
|
45 |
45 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
218 |
126 |
$5K |
| 90837 |
Psychotherapy, 53 minutes with patient |
184 |
51 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
597 |
400 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
32 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
176 |
99 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
407 |
251 |
$2K |
| 99342 |
|
95 |
52 |
$2K |
| 90688 |
|
262 |
146 |
$1K |
| D4910 |
|
57 |
53 |
$1K |
| 99188 |
|
115 |
63 |
$1K |
| 0012A |
|
39 |
38 |
$936.87 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
36 |
13 |
$898.17 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$819.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$719.02 |
| 90686 |
|
97 |
51 |
$670.00 |
| 99348 |
|
38 |
18 |
$669.60 |
| 0011A |
|
44 |
43 |
$619.92 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
23 |
13 |
$600.00 |
| 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 |
31 |
26 |
$380.60 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
30 |
24 |
$279.95 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
16 |
$99.44 |
| 90670 |
|
24 |
12 |
$82.50 |
| D9995 |
|
12 |
12 |
$49.08 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
74 |
43 |
$13.23 |
| 90656 |
|
22 |
22 |
$12.40 |
| 3079F |
|
1,964 |
1,459 |
$0.60 |
| 3077F |
|
760 |
602 |
$0.27 |
| 3074F |
|
3,595 |
2,824 |
$0.23 |
| 3078F |
|
2,868 |
2,104 |
$0.18 |
| 3075F |
|
375 |
284 |
$0.18 |
| 3080F |
|
519 |
396 |
$0.18 |
| D0191 |
|
130 |
129 |
$0.00 |
| 90715 |
|
16 |
16 |
$0.00 |
| 90658 |
|
14 |
14 |
$0.00 |
| 3008F |
|
6,541 |
3,803 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| 91301 |
|
81 |
79 |
$0.00 |
| 86580 |
|
15 |
12 |
$0.00 |