| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,166 |
677 |
$131K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,641 |
1,359 |
$50K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
697 |
590 |
$27K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
181 |
143 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
93 |
89 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
129 |
97 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
63 |
52 |
$3K |
| 90837 |
Psychotherapy, 53 minutes with patient |
48 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
245 |
215 |
$2K |
| 99173 |
|
116 |
101 |
$1K |
| D0274 |
Bitewings - four radiographic images |
93 |
80 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
32 |
30 |
$1K |
| D1206 |
Topical application of fluoride varnish |
110 |
92 |
$884.45 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$828.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
324 |
89 |
$792.22 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
35 |
$772.92 |
| 80061 |
Lipid panel |
87 |
73 |
$589.16 |
| 92551 |
|
59 |
52 |
$585.36 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
16 |
13 |
$548.82 |
| D1120 |
Prophylaxis - child |
17 |
17 |
$427.70 |
| D1110 |
Prophylaxis - adult |
56 |
38 |
$393.28 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
68 |
59 |
$385.60 |
| 83655 |
|
54 |
48 |
$363.30 |
| D0120 |
Periodic oral evaluation - established patient |
37 |
25 |
$307.12 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
25 |
24 |
$148.21 |
| 85018 |
|
56 |
51 |
$111.39 |
| 81025 |
|
28 |
27 |
$77.49 |
| 1160F |
|
3,020 |
2,460 |
$0.00 |
| 3078F |
|
2,250 |
1,853 |
$0.00 |
| 1159F |
|
3,019 |
2,460 |
$0.00 |
| 90461 |
|
223 |
167 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
618 |
480 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
73 |
65 |
$0.00 |
| 3077F |
|
77 |
62 |
$0.00 |
| D0191 |
|
14 |
14 |
$0.00 |
| 3074F |
|
2,673 |
2,203 |
$0.00 |
| 3008F |
|
3,736 |
3,060 |
$0.00 |
| 3079F |
|
476 |
404 |
$0.00 |
| D1330 |
|
327 |
273 |
$0.00 |
| 4010F |
|
81 |
59 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
36 |
25 |
$0.00 |
| D0603 |
|
16 |
15 |
$0.00 |
| 3075F |
|
69 |
62 |
$0.00 |
| 3080F |
|
15 |
12 |
$0.00 |