| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
40,933 |
31,862 |
$2.91M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16,763 |
10,269 |
$506K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,606 |
8,447 |
$279K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,791 |
2,130 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,839 |
2,299 |
$99K |
| D1110 |
Prophylaxis - adult |
5,108 |
3,642 |
$67K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,057 |
1,161 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,186 |
3,096 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
6,024 |
4,329 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
5,480 |
3,835 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,383 |
851 |
$35K |
| D0330 |
Panoramic radiographic image |
1,978 |
1,468 |
$33K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,687 |
1,185 |
$32K |
| D1120 |
Prophylaxis - child |
3,289 |
2,496 |
$28K |
| 90834 |
Psychotherapy, 45 minutes with patient |
968 |
381 |
$26K |
| D0274 |
Bitewings - four radiographic images |
3,340 |
2,458 |
$26K |
| D1206 |
Topical application of fluoride varnish |
4,112 |
3,154 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
626 |
381 |
$17K |
| 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 |
1,666 |
1,463 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
8,062 |
5,685 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,237 |
2,687 |
$15K |
| 99215 |
Prolong outpt/office vis |
315 |
189 |
$14K |
| 36415 |
Collection of venous blood by venipuncture |
10,730 |
6,510 |
$13K |
| 90686 |
|
1,907 |
1,200 |
$12K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
569 |
288 |
$9K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,453 |
1,591 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,239 |
748 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
473 |
298 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
185 |
155 |
$7K |
| 99442 |
|
624 |
339 |
$7K |
| Q3014 |
Telehealth originating site facility fee |
620 |
330 |
$7K |
| D0272 |
Bitewings - two radiographic images |
1,557 |
1,179 |
$6K |
| 90791 |
Psychiatric diagnostic evaluation |
96 |
50 |
$4K |
| 82962 |
|
2,759 |
1,761 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
446 |
298 |
$3K |
| D1351 |
Sealant - per tooth |
205 |
71 |
$3K |
| 99443 |
|
160 |
89 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
93 |
63 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
57 |
49 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
18 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
36 |
25 |
$838.12 |
| D1354 |
|
208 |
46 |
$825.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
64 |
37 |
$812.69 |
| 92551 |
|
182 |
125 |
$809.06 |
| 99441 |
|
130 |
77 |
$806.40 |
| 0012A |
|
13 |
13 |
$518.44 |
| 99173 |
|
462 |
276 |
$460.56 |
| 90674 |
|
29 |
21 |
$453.53 |
| 0124A |
|
17 |
12 |
$303.16 |
| D0180 |
|
15 |
12 |
$79.05 |
| 90661 |
|
95 |
92 |
$77.38 |
| 90656 |
|
61 |
58 |
$69.29 |
| 81002 |
|
121 |
115 |
$63.38 |
| 3079F |
|
4,296 |
2,383 |
$1.75 |
| 3074F |
|
3,065 |
1,658 |
$0.94 |
| 3075F |
|
1,712 |
937 |
$0.78 |
| 3077F |
|
1,437 |
805 |
$0.73 |
| 3078F |
|
2,348 |
1,281 |
$0.62 |
| 3080F |
|
694 |
370 |
$0.39 |
| 3044F |
|
152 |
97 |
$0.14 |
| 91301 |
|
14 |
14 |
$0.14 |
| 1125F |
|
152 |
83 |
$0.00 |
| 3008F |
|
224 |
207 |
$0.00 |
| 1126F |
|
116 |
60 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 90685 |
|
55 |
39 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
192 |
183 |
$0.00 |
| 90670 |
|
56 |
41 |
$0.00 |
| 99188 |
|
21 |
12 |
$0.00 |