| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,975 |
26,710 |
$2.08M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,453 |
6,696 |
$257K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
11,503 |
5,036 |
$165K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,391 |
1,282 |
$67K |
| D0330 |
Panoramic radiographic image |
3,769 |
2,771 |
$63K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,526 |
1,321 |
$57K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,931 |
1,026 |
$56K |
| D1351 |
Sealant - per tooth |
4,762 |
1,086 |
$53K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,905 |
1,779 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,372 |
667 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,376 |
3,175 |
$38K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,088 |
573 |
$37K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,760 |
1,684 |
$35K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,134 |
683 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,530 |
916 |
$29K |
| D1120 |
Prophylaxis - child |
4,362 |
3,283 |
$29K |
| D1110 |
Prophylaxis - adult |
2,524 |
1,812 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,491 |
932 |
$27K |
| 92015 |
Determination of refractive state |
5,128 |
3,409 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
3,721 |
2,790 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,342 |
3,254 |
$17K |
| 90791 |
Psychiatric diagnostic evaluation |
315 |
187 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,501 |
1,029 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,082 |
766 |
$11K |
| D0274 |
Bitewings - four radiographic images |
2,660 |
2,087 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,457 |
1,507 |
$10K |
| D1354 |
|
1,007 |
259 |
$10K |
| 92551 |
|
2,016 |
1,178 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
296 |
172 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,688 |
1,303 |
$4K |
| 90651 |
|
728 |
414 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
264 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
154 |
154 |
$3K |
| V2020 |
Frames, purchases |
235 |
228 |
$3K |
| 92341 |
|
510 |
283 |
$3K |
| 90670 |
|
1,397 |
836 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
28 |
$1K |
| 90734 |
|
538 |
290 |
$1K |
| 99173 |
|
1,119 |
628 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
113 |
113 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
881 |
662 |
$915.00 |
| 99384 |
|
25 |
12 |
$823.73 |
| 90674 |
|
717 |
408 |
$776.24 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
145 |
104 |
$757.66 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
118 |
71 |
$745.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
511 |
283 |
$590.00 |
| 90756 |
|
57 |
40 |
$544.83 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
26 |
24 |
$398.54 |
| 92002 |
|
29 |
27 |
$383.46 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
56 |
16 |
$378.50 |
| 90633 |
|
897 |
529 |
$367.13 |
| 90723 |
|
412 |
239 |
$365.68 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
51 |
28 |
$340.11 |
| 90686 |
|
1,106 |
707 |
$337.87 |
| 90688 |
|
280 |
171 |
$218.77 |
| 90715 |
|
191 |
99 |
$190.14 |
| 90661 |
|
88 |
86 |
$181.47 |
| 90710 |
|
283 |
164 |
$162.20 |
| 90647 |
|
866 |
507 |
$136.42 |
| 90620 |
|
304 |
179 |
$113.67 |
| 90658 |
|
17 |
12 |
$52.99 |
| 90700 |
|
254 |
154 |
$34.92 |
| 90687 |
|
379 |
248 |
$30.56 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
24 |
$25.33 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
13 |
$14.50 |
| 90681 |
|
68 |
39 |
$0.14 |
| 90680 |
|
32 |
13 |
$0.04 |
| 90707 |
|
57 |
37 |
$0.03 |
| 90716 |
|
43 |
26 |
$0.03 |
| 90713 |
|
103 |
70 |
$0.01 |
| 3078F |
|
8,468 |
5,509 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
299 |
172 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
8,535 |
5,320 |
$0.00 |
| 3077F |
|
302 |
172 |
$0.00 |
| 1159F |
|
97 |
61 |
$0.00 |
| 90671 |
|
17 |
14 |
$0.00 |
| 3074F |
|
9,047 |
5,876 |
$0.00 |
| 2001F |
|
11,375 |
7,088 |
$0.00 |
| 3008F |
|
11,381 |
7,083 |
$0.00 |
| 1036F |
|
9,047 |
5,678 |
$0.00 |
| G8755 |
Most recent diastolic blood pressure >= 90 mmhg |
111 |
54 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
8,655 |
5,385 |
$0.00 |
| 3079F |
|
1,426 |
927 |
$0.00 |
| 3075F |
|
469 |
300 |
$0.00 |
| 3080F |
|
22 |
12 |
$0.00 |
| D0603 |
|
51 |
31 |
$0.00 |