| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,867 |
20,647 |
$4.72M |
| D0999 |
Unspecified diagnostic procedure, by report |
23,183 |
11,539 |
$2.65M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,050 |
1,132 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,999 |
1,420 |
$6K |
| D1110 |
Prophylaxis - adult |
3,732 |
3,135 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,202 |
1,760 |
$3K |
| D0330 |
Panoramic radiographic image |
852 |
684 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
81 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,279 |
17,181 |
$1K |
| D0272 |
Bitewings - two radiographic images |
3,701 |
3,171 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
4,577 |
3,932 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
7,257 |
1,729 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,531 |
6,311 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,703 |
2,162 |
$503.42 |
| D1999 |
|
70 |
69 |
$338.92 |
| D1120 |
Prophylaxis - child |
2,058 |
1,826 |
$35.02 |
| 90658 |
|
217 |
193 |
$32.80 |
| D1206 |
Topical application of fluoride varnish |
240 |
209 |
$24.29 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,227 |
1,999 |
$19.77 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
5,397 |
3,971 |
$12.92 |
| 36415 |
Collection of venous blood by venipuncture |
6,854 |
5,912 |
$10.75 |
| 81002 |
|
1,837 |
950 |
$2.54 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
685 |
578 |
$0.76 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
418 |
327 |
$0.39 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
473 |
372 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
895 |
648 |
$0.00 |
| 1159F |
|
101 |
81 |
$0.00 |
| 99307 |
|
3,738 |
1,019 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
42 |
40 |
$0.00 |
| 81025 |
|
242 |
82 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
313 |
185 |
$0.00 |
| 1158F |
|
101 |
81 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
36 |
35 |
$0.00 |
| 86318 |
|
228 |
161 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
71 |
59 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
191 |
158 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
45 |
42 |
$0.00 |
| 1160F |
|
101 |
81 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$0.00 |
| D9110 |
|
19 |
13 |
$0.00 |
| D5110 |
|
17 |
16 |
$0.00 |
| 11596 |
|
1,944 |
1,433 |
$0.00 |
| 11606 |
|
1,944 |
1,433 |
$0.00 |
| 11256 |
|
534 |
401 |
$0.00 |
| 11706 |
|
1,944 |
1,433 |
$0.00 |
| 11586 |
|
1,944 |
1,433 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
1,456 |
1,131 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
218 |
161 |
$0.00 |
| 3079F |
|
83 |
67 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
617 |
362 |
$0.00 |
| 1170F |
|
101 |
81 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
753 |
595 |
$0.00 |
| 1125F |
|
51 |
43 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
403 |
295 |
$0.00 |
| 11266 |
|
739 |
576 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
20 |
20 |
$0.00 |
| 1126F |
|
50 |
43 |
$0.00 |
| 3074F |
|
30 |
27 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
16 |
$0.00 |