| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,801 |
7,513 |
$470K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
8,115 |
1,784 |
$65K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,690 |
887 |
$37K |
| D0330 |
Panoramic radiographic image |
1,374 |
815 |
$25K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
664 |
356 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,417 |
845 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
903 |
659 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,808 |
1,396 |
$11K |
| D1206 |
Topical application of fluoride varnish |
1,116 |
694 |
$8K |
| D1110 |
Prophylaxis - adult |
467 |
300 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
869 |
469 |
$8K |
| 99384 |
|
214 |
120 |
$8K |
| 92551 |
|
2,323 |
1,293 |
$8K |
| 92015 |
Determination of refractive state |
2,938 |
2,228 |
$7K |
| D1120 |
Prophylaxis - child |
729 |
454 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
224 |
120 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
177 |
90 |
$6K |
| 99383 |
|
147 |
80 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
59 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
97 |
56 |
$3K |
| 99173 |
|
2,189 |
1,196 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
252 |
167 |
$2K |
| 90651 |
|
414 |
242 |
$2K |
| 99382 |
|
47 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
915 |
499 |
$2K |
| D0274 |
Bitewings - four radiographic images |
468 |
357 |
$2K |
| 3008F |
|
442 |
290 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
88 |
45 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
286 |
104 |
$805.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
171 |
139 |
$777.27 |
| 90715 |
|
338 |
205 |
$771.70 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
13 |
$722.17 |
| 85018 |
|
743 |
427 |
$715.16 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
30 |
13 |
$637.52 |
| 90686 |
|
640 |
369 |
$633.62 |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
12 |
$264.72 |
| D0272 |
Bitewings - two radiographic images |
85 |
67 |
$230.00 |
| 90688 |
|
50 |
29 |
$189.60 |
| 92341 |
|
17 |
13 |
$93.06 |
| 36416 |
|
52 |
29 |
$90.75 |
| D0270 |
|
27 |
15 |
$60.00 |
| 90670 |
|
339 |
202 |
$0.00 |
| 90633 |
|
530 |
315 |
$0.00 |
| 90710 |
|
444 |
254 |
$0.00 |
| 90707 |
|
49 |
33 |
$0.00 |
| 90734 |
|
407 |
229 |
$0.00 |
| 1160F |
|
55 |
42 |
$0.00 |
| 3078F |
|
45 |
41 |
$0.00 |
| 4004F |
|
72 |
37 |
$0.00 |
| 90696 |
|
225 |
119 |
$0.00 |
| 90716 |
|
54 |
37 |
$0.00 |
| 1036F |
|
215 |
124 |
$0.00 |
| 90698 |
|
161 |
97 |
$0.00 |
| 3074F |
|
27 |
24 |
$0.00 |
| 2023F |
|
36 |
19 |
$0.00 |
| 90744 |
|
182 |
107 |
$0.00 |
| 90677 |
|
21 |
14 |
$0.00 |