| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
132,576 |
91,078 |
$8.05M |
| D0330 |
Panoramic radiographic image |
5,169 |
4,324 |
$40K |
| D1120 |
Prophylaxis - child |
11,561 |
9,753 |
$34K |
| D1206 |
Topical application of fluoride varnish |
14,643 |
12,351 |
$33K |
| D1110 |
Prophylaxis - adult |
8,593 |
7,214 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
16,063 |
13,514 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,118 |
5,132 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,658 |
1,116 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,914 |
1,290 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,146 |
1,511 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
34,359 |
26,818 |
$12K |
| 90834 |
Psychotherapy, 45 minutes with patient |
11,407 |
5,985 |
$9K |
| D0274 |
Bitewings - four radiographic images |
7,324 |
6,179 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,626 |
4,410 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
6,994 |
5,810 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
4,999 |
4,141 |
$3K |
| D0272 |
Bitewings - two radiographic images |
2,688 |
2,194 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,877 |
5,614 |
$1K |
| 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 |
50 |
45 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
796 |
264 |
$771.50 |
| 99442 |
|
4,081 |
3,009 |
$627.32 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
15 |
$614.25 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,624 |
1,236 |
$542.25 |
| 90791 |
Psychiatric diagnostic evaluation |
788 |
593 |
$421.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
358 |
329 |
$231.70 |
| D0270 |
|
343 |
292 |
$102.40 |
| 99215 |
Prolong outpt/office vis |
226 |
192 |
$89.63 |
| 90832 |
Psychotherapy, 30 minutes with patient |
145 |
98 |
$79.53 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
424 |
361 |
$66.18 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
182 |
160 |
$51.40 |
| 99422 |
|
30 |
25 |
$48.04 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
365 |
332 |
$39.25 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
37 |
34 |
$29.76 |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
65 |
55 |
$29.06 |
| 99406 |
|
145 |
114 |
$18.86 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
82 |
46 |
$15.23 |
| 96127 |
|
87 |
82 |
$7.94 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
197 |
172 |
$3.75 |
| 81002 |
|
452 |
345 |
$2.61 |
| S9470 |
Nutritional counseling, dietitian visit |
74 |
69 |
$0.00 |
| 3078F |
|
85 |
67 |
$0.00 |
| 3077F |
|
75 |
62 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
189 |
176 |
$0.00 |
| D2140 |
|
16 |
15 |
$0.00 |
| 99173 |
|
300 |
273 |
$0.00 |
| 81025 |
|
15 |
12 |
$0.00 |
| 90670 |
|
68 |
57 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
57 |
52 |
$0.00 |
| 90734 |
|
63 |
61 |
$0.00 |
| 90633 |
|
18 |
16 |
$0.00 |
| 96160 |
|
90 |
83 |
$0.00 |
| 90715 |
|
30 |
29 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
10,626 |
8,322 |
$0.00 |
| 1000F |
|
46 |
42 |
$0.00 |
| D0602 |
|
149 |
132 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
16 |
$0.00 |
| 90686 |
|
55 |
46 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
54 |
39 |
$0.00 |
| D2331 |
|
15 |
12 |
$0.00 |
| D0603 |
|
230 |
178 |
$0.00 |
| D1351 |
Sealant - per tooth |
518 |
130 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
99 |
62 |
$0.00 |
| 3700F |
|
13 |
13 |
$0.00 |
| 3074F |
|
78 |
61 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$0.00 |
| 3079F |
|
75 |
59 |
$0.00 |
| 92587 |
|
27 |
27 |
$0.00 |
| 99441 |
|
87 |
69 |
$0.00 |
| 90651 |
|
48 |
46 |
$0.00 |
| S9452 |
Nutrition classes, non-physician provider, per session |
19 |
19 |
$0.00 |
| 90674 |
|
12 |
12 |
$0.00 |
| 90698 |
|
47 |
38 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
22 |
$0.00 |