| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,114 |
12,012 |
$1.16M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,726 |
5,623 |
$263K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,988 |
1,611 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,018 |
524 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,315 |
710 |
$56K |
| D0330 |
Panoramic radiographic image |
1,858 |
1,348 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,239 |
651 |
$48K |
| D1351 |
Sealant - per tooth |
1,571 |
371 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,302 |
1,619 |
$36K |
| D1206 |
Topical application of fluoride varnish |
2,333 |
1,586 |
$31K |
| D1110 |
Prophylaxis - adult |
1,172 |
830 |
$28K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
901 |
473 |
$27K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
932 |
474 |
$25K |
| D1120 |
Prophylaxis - child |
1,454 |
1,064 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,481 |
1,045 |
$18K |
| 90791 |
Psychiatric diagnostic evaluation |
320 |
180 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,055 |
767 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
417 |
233 |
$12K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
310 |
176 |
$11K |
| D0274 |
Bitewings - four radiographic images |
875 |
714 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,403 |
978 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
869 |
644 |
$4K |
| D0272 |
Bitewings - two radiographic images |
570 |
441 |
$4K |
| D2335 |
|
12 |
12 |
$2K |
| 99384 |
|
48 |
27 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
55 |
25 |
$2K |
| 92551 |
|
397 |
233 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
186 |
106 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
98 |
69 |
$1K |
| 90651 |
|
101 |
57 |
$1K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
48 |
22 |
$959.19 |
| 90670 |
|
428 |
232 |
$858.16 |
| 99381 |
|
26 |
13 |
$773.89 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
125 |
59 |
$766.47 |
| D2331 |
|
24 |
12 |
$761.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
249 |
106 |
$715.86 |
| 99173 |
|
431 |
262 |
$592.56 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$520.00 |
| 90671 |
|
138 |
86 |
$506.00 |
| 92015 |
Determination of refractive state |
229 |
179 |
$437.43 |
| 80305 |
|
81 |
41 |
$354.52 |
| D1354 |
|
52 |
13 |
$330.00 |
| 90674 |
|
146 |
88 |
$309.31 |
| 90633 |
|
345 |
184 |
$295.61 |
| 90710 |
|
125 |
70 |
$264.57 |
| 90723 |
|
268 |
146 |
$185.23 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
54 |
41 |
$174.16 |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
13 |
$157.84 |
| 90734 |
|
204 |
114 |
$116.66 |
| 90661 |
|
16 |
16 |
$110.55 |
| 90647 |
|
184 |
98 |
$92.73 |
| 90715 |
|
82 |
44 |
$73.85 |
| 36415 |
Collection of venous blood by venipuncture |
20 |
12 |
$58.25 |
| 90687 |
|
157 |
90 |
$9.76 |
| 90681 |
|
57 |
38 |
$0.07 |
| 90696 |
|
24 |
13 |
$0.06 |
| 90649 |
|
31 |
16 |
$0.01 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
7,299 |
3,524 |
$0.00 |
| 3074F |
|
6,596 |
3,305 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
710 |
346 |
$0.00 |
| 3008F |
|
9,689 |
4,812 |
$0.00 |
| 2001F |
|
9,708 |
4,812 |
$0.00 |
| 1036F |
|
5,378 |
2,758 |
$0.00 |
| 3079F |
|
2,145 |
1,035 |
$0.00 |
| 3075F |
|
998 |
487 |
$0.00 |
| 3080F |
|
582 |
293 |
$0.00 |
| 90697 |
|
15 |
14 |
$0.00 |
| 3077F |
|
1,027 |
497 |
$0.00 |
| 3078F |
|
5,752 |
2,888 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
7,072 |
3,408 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
996 |
485 |
$0.00 |
| 4004F |
|
344 |
179 |
$0.00 |
| 1159F |
|
86 |
41 |
$0.00 |