| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,048 |
2,739 |
$326K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,570 |
933 |
$41K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,716 |
974 |
$40K |
| D0330 |
Panoramic radiographic image |
770 |
515 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
979 |
606 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
339 |
137 |
$11K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
433 |
227 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
533 |
403 |
$6K |
| D1110 |
Prophylaxis - adult |
290 |
184 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
383 |
217 |
$4K |
| D1206 |
Topical application of fluoride varnish |
434 |
296 |
$3K |
| D1120 |
Prophylaxis - child |
225 |
166 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
617 |
315 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
174 |
96 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
63 |
29 |
$1K |
| 80305 |
|
343 |
70 |
$1K |
| 99384 |
|
27 |
15 |
$972.56 |
| 82962 |
|
959 |
396 |
$825.34 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
14 |
$716.94 |
| 90686 |
|
93 |
58 |
$452.44 |
| 82274 |
|
72 |
43 |
$279.00 |
| D0272 |
Bitewings - two radiographic images |
65 |
47 |
$270.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
27 |
12 |
$255.29 |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
69 |
$225.00 |
| D0274 |
Bitewings - four radiographic images |
55 |
43 |
$200.00 |
| 99406 |
|
234 |
105 |
$183.49 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
19 |
15 |
$155.77 |
| 86803 |
|
15 |
12 |
$96.28 |
| D1351 |
Sealant - per tooth |
2,036 |
286 |
$88.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
25 |
15 |
$72.85 |
| 81025 |
|
26 |
12 |
$65.66 |
| D0270 |
|
26 |
15 |
$55.00 |
| 81002 |
|
50 |
26 |
$34.36 |
| 90715 |
|
23 |
13 |
$10.00 |
| 99408 |
|
96 |
49 |
$8.40 |
| 90461 |
|
76 |
40 |
$5.00 |
| 96160 |
|
124 |
68 |
$0.30 |
| 3077F |
|
334 |
143 |
$0.00 |
| 90633 |
|
21 |
13 |
$0.00 |
| 3078F |
|
912 |
379 |
$0.00 |
| 3045F |
|
43 |
12 |
$0.00 |
| 3075F |
|
530 |
213 |
$0.00 |
| 3074F |
|
1,211 |
491 |
$0.00 |
| 3080F |
|
329 |
139 |
$0.00 |
| 3079F |
|
827 |
349 |
$0.00 |
| 3044F |
|
1,000 |
380 |
$0.00 |
| G0396 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
20 |
13 |
$0.00 |
| 90651 |
|
30 |
16 |
$0.00 |