| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,915 |
12,872 |
$2.71M |
| D1206 |
Topical application of fluoride varnish |
20,703 |
18,318 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
13,507 |
12,171 |
$169K |
| D1110 |
Prophylaxis - adult |
8,520 |
7,391 |
$154K |
| D1120 |
Prophylaxis - child |
8,603 |
7,517 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,326 |
1,766 |
$92K |
| D0274 |
Bitewings - four radiographic images |
8,819 |
7,388 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
15,573 |
13,225 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,015 |
4,096 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,218 |
1,573 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
5,432 |
4,787 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,128 |
8,150 |
$46K |
| D1351 |
Sealant - per tooth |
3,383 |
1,072 |
$38K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,376 |
1,214 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,030 |
947 |
$29K |
| D0330 |
Panoramic radiographic image |
2,640 |
2,162 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
986 |
846 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,479 |
1,941 |
$22K |
| D0191 |
|
3,917 |
3,590 |
$21K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
751 |
686 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
648 |
410 |
$21K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
435 |
377 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
183 |
161 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
86 |
85 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
584 |
437 |
$5K |
| D2140 |
|
113 |
73 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
73 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
50 |
50 |
$3K |
| D0240 |
|
320 |
151 |
$3K |
| 99173 |
|
175 |
165 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
43 |
41 |
$2K |
| 99000 |
|
1,348 |
1,146 |
$2K |
| 92551 |
|
229 |
221 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
102 |
45 |
$2K |
| 99201 |
|
117 |
107 |
$2K |
| 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 |
61 |
57 |
$2K |
| 0071A |
|
74 |
42 |
$2K |
| 3008F |
|
213 |
196 |
$1K |
| 90791 |
Psychiatric diagnostic evaluation |
25 |
14 |
$1K |
| D0170 |
|
85 |
73 |
$1K |
| 0072A |
|
25 |
21 |
$765.04 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
156 |
114 |
$688.48 |
| 80061 |
Lipid panel |
32 |
30 |
$329.28 |
| D9110 |
|
14 |
14 |
$315.46 |
| 96127 |
|
88 |
82 |
$311.84 |
| 99001 |
|
332 |
265 |
$299.92 |
| D0270 |
|
47 |
45 |
$230.94 |
| 90674 |
|
81 |
78 |
$218.46 |
| 99188 |
|
16 |
15 |
$167.57 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
22 |
16 |
$129.45 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
30 |
28 |
$107.54 |
| 90685 |
|
23 |
23 |
$66.20 |
| 90686 |
|
93 |
75 |
$56.52 |
| 90651 |
|
34 |
27 |
$49.70 |
| 90734 |
|
13 |
13 |
$43.03 |
| 90715 |
|
12 |
12 |
$36.41 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
61 |
57 |
$34.20 |
| 91307 |
|
75 |
53 |
$0.05 |
| D9990 |
|
37 |
33 |
$0.00 |
| 1159F |
|
16 |
14 |
$0.00 |
| 1160F |
|
16 |
14 |
$0.00 |
| 90756 |
|
12 |
12 |
$0.00 |
| D0602 |
|
387 |
363 |
$0.00 |
| D1330 |
|
2,023 |
1,868 |
$0.00 |
| D0601 |
|
647 |
626 |
$0.00 |
| D0603 |
|
1,483 |
1,408 |
$0.00 |
| D1310 |
|
35 |
35 |
$0.00 |
| D1353 |
|
38 |
21 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
14 |
$0.00 |