| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,198 |
4,989 |
$1.06M |
| D0120 |
Periodic oral evaluation - established patient |
1,227 |
997 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
333 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
170 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
101 |
$4K |
| D1120 |
Prophylaxis - child |
220 |
220 |
$3K |
| D1110 |
Prophylaxis - adult |
168 |
168 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
81 |
$3K |
| D2140 |
|
82 |
66 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
60 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
92 |
92 |
$2K |
| D0274 |
Bitewings - four radiographic images |
295 |
295 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
51 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
213 |
213 |
$2K |
| D1351 |
Sealant - per tooth |
198 |
58 |
$2K |
| D4355 |
|
25 |
25 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
483 |
468 |
$1K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$866.25 |
| D2335 |
|
15 |
14 |
$810.00 |
| D2330 |
|
22 |
17 |
$781.00 |
| D2331 |
|
14 |
14 |
$595.00 |
| D4346 |
|
15 |
15 |
$525.00 |
| D0272 |
Bitewings - two radiographic images |
86 |
86 |
$430.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
101 |
101 |
$407.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$210.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$195.00 |
| D2940 |
|
13 |
12 |
$78.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,005 |
1,668 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
205 |
204 |
$0.00 |
| D1999 |
|
57 |
38 |
$0.00 |
| 99173 |
|
14 |
14 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
81 |
70 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,291 |
1,967 |
$0.00 |
| 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 |
1,004 |
871 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
102 |
102 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
25 |
25 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
681 |
642 |
$0.00 |
| 92551 |
|
12 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$0.00 |