| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
35,896 |
22,387 |
$1.97M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,665 |
3,877 |
$170K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,859 |
4,502 |
$73K |
| D1351 |
Sealant - per tooth |
9,905 |
2,117 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
859 |
514 |
$33K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,715 |
4,167 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
830 |
454 |
$26K |
| D1120 |
Prophylaxis - child |
5,854 |
4,275 |
$24K |
| 92015 |
Determination of refractive state |
9,110 |
5,810 |
$23K |
| D1206 |
Topical application of fluoride varnish |
5,227 |
3,610 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
5,367 |
3,845 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,957 |
1,114 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,049 |
589 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,088 |
680 |
$12K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,485 |
781 |
$9K |
| D0274 |
Bitewings - four radiographic images |
3,552 |
2,463 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,558 |
1,789 |
$8K |
| D1110 |
Prophylaxis - adult |
1,259 |
840 |
$7K |
| D1354 |
|
2,782 |
872 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
457 |
238 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,824 |
2,095 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,820 |
3,232 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
5,069 |
3,536 |
$5K |
| D0330 |
Panoramic radiographic image |
1,766 |
1,191 |
$5K |
| D2140 |
|
308 |
219 |
$5K |
| 90686 |
|
567 |
377 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
83 |
47 |
$2K |
| 90651 |
|
36 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
25 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
402 |
261 |
$1K |
| 92341 |
|
261 |
151 |
$1K |
| D0240 |
|
41 |
19 |
$779.62 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
21 |
12 |
$580.49 |
| 90688 |
|
104 |
47 |
$572.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,589 |
1,395 |
$482.25 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
22 |
17 |
$441.21 |
| 96160 |
|
24 |
17 |
$30.87 |
| 90658 |
|
36 |
25 |
$20.00 |
| 3078F |
|
5,139 |
2,919 |
$0.00 |
| 3074F |
|
3,643 |
2,842 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
115 |
89 |
$0.00 |
| 3008F |
|
1,681 |
877 |
$0.00 |
| D0603 |
|
192 |
176 |
$0.00 |
| D2160 |
|
15 |
12 |
$0.00 |
| 90656 |
|
14 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
14 |
$0.00 |