| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
222,668 |
208,517 |
$51.18M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
105,229 |
99,574 |
$372K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
246 |
246 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,202 |
1,594 |
$222K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15,623 |
15,307 |
$186K |
| D9999 |
Unspecified adjunctive procedure, by report |
474 |
467 |
$139K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
862 |
673 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,532 |
3,307 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,113 |
853 |
$68K |
| 0002A |
|
1,209 |
1,209 |
$48K |
| 0001A |
|
1,150 |
1,148 |
$46K |
| 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 |
1,398 |
1,297 |
$44K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,099 |
4,070 |
$36K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,323 |
4,323 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
953 |
952 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,953 |
4,950 |
$26K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,806 |
2,806 |
$24K |
| 0071A |
|
562 |
558 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
164 |
$22K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
5,732 |
5,725 |
$22K |
| 0072A |
|
543 |
543 |
$22K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
10,419 |
10,388 |
$20K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
1,303 |
1,300 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
558 |
557 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
372 |
$11K |
| D9310 |
|
211 |
211 |
$10K |
| V2020 |
Frames, purchases |
979 |
978 |
$10K |
| 90832 |
Psychotherapy, 30 minutes with patient |
197 |
157 |
$9K |
| 87428 |
|
5,392 |
5,380 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,617 |
3,561 |
$8K |
| 0013A |
|
189 |
189 |
$8K |
| 90791 |
Psychiatric diagnostic evaluation |
566 |
566 |
$7K |
| 0003A |
|
161 |
161 |
$6K |
| 0012A |
|
167 |
167 |
$6K |
| 0011A |
|
212 |
212 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
586 |
586 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
778 |
778 |
$3K |
| 90474 |
|
586 |
585 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,546 |
4,532 |
$3K |
| 99215 |
Prolong outpt/office vis |
326 |
325 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,759 |
2,757 |
$2K |
| 90656 |
|
202 |
201 |
$2K |
| 0054A |
|
43 |
43 |
$2K |
| D1120 |
Prophylaxis - child |
15,515 |
15,513 |
$2K |
| 97802 |
|
25 |
24 |
$1K |
| 0004A |
|
30 |
30 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
140 |
140 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
17,978 |
17,975 |
$1K |
| D3120 |
|
28 |
24 |
$833.70 |
| 90715 |
|
396 |
395 |
$698.25 |
| 0111A |
|
17 |
17 |
$680.00 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$575.12 |
| 0124A |
|
14 |
14 |
$560.00 |
| 0031A |
|
13 |
13 |
$520.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$488.25 |
| 0051A |
|
12 |
12 |
$480.00 |
| 90746 |
|
12 |
12 |
$461.23 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
240 |
240 |
$442.89 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
48 |
48 |
$367.31 |
| D0274 |
Bitewings - four radiographic images |
7,363 |
7,362 |
$347.73 |
| D0272 |
Bitewings - two radiographic images |
1,620 |
1,620 |
$292.64 |
| D1110 |
Prophylaxis - adult |
6,592 |
6,591 |
$283.64 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$251.10 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
275 |
275 |
$220.38 |
| 99406 |
|
13 |
12 |
$179.66 |
| D1206 |
Topical application of fluoride varnish |
22,879 |
22,856 |
$157.31 |
| 99381 |
|
138 |
138 |
$95.69 |
| 81025 |
|
336 |
335 |
$57.29 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,962 |
1,962 |
$30.50 |
| 81003 |
|
106 |
92 |
$24.00 |
| 88720 |
|
94 |
79 |
$22.35 |
| 90633 |
|
1,170 |
1,170 |
$0.07 |
| 90734 |
|
932 |
932 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
1,016 |
1,016 |
$0.00 |
| 90681 |
|
814 |
813 |
$0.00 |
| 90671 |
|
711 |
707 |
$0.00 |
| 3078F |
|
4,529 |
4,354 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,117 |
1,116 |
$0.00 |
| 92015 |
Determination of refractive state |
802 |
802 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,287 |
1,287 |
$0.00 |
| 90670 |
|
1,680 |
1,680 |
$0.00 |
| 90700 |
|
135 |
135 |
$0.00 |
| 3077F |
|
27 |
26 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
773 |
773 |
$0.00 |
| 80305 |
|
105 |
101 |
$0.00 |
| D1354 |
|
1,010 |
347 |
$0.00 |
| 90710 |
|
222 |
222 |
$0.00 |
| 90661 |
|
312 |
312 |
$0.00 |
| 97803 |
|
13 |
13 |
$0.00 |
| 90707 |
|
74 |
74 |
$0.00 |
| 99188 |
|
13 |
13 |
$0.00 |
| 3008F |
|
7,373 |
7,054 |
$0.00 |
| 90647 |
|
1,926 |
1,925 |
$0.00 |
| 1111F |
|
6,324 |
6,039 |
$0.00 |
| 87807 |
|
661 |
659 |
$0.00 |
| 90651 |
|
1,440 |
1,440 |
$0.00 |
| 90723 |
|
1,726 |
1,722 |
$0.00 |
| 90716 |
|
90 |
90 |
$0.00 |
| 3074F |
|
5,266 |
5,058 |
$0.00 |
| 90686 |
|
3,383 |
3,383 |
$0.00 |
| D1351 |
Sealant - per tooth |
5,926 |
1,890 |
$0.00 |
| 90677 |
|
222 |
222 |
$0.00 |
| 90674 |
|
1,497 |
1,497 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
533 |
532 |
$0.00 |
| 99386 |
|
14 |
14 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 4010F |
|
44 |
43 |
$0.00 |
| 90620 |
|
285 |
285 |
$0.00 |
| 3079F |
|
675 |
671 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
160 |
160 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
961 |
960 |
$0.00 |
| 90696 |
|
214 |
214 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
38 |
38 |
$0.00 |
| 99385 |
|
12 |
12 |
$0.00 |
| 1126F |
|
12 |
12 |
$0.00 |
| 1125F |
|
21 |
21 |
$0.00 |