| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,292 |
10,433 |
$1.26M |
| 99199 |
Unlisted special service, procedure or report |
87,486 |
37,850 |
$475K |
| D0140 |
Limited oral evaluation - problem focused |
594 |
438 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
254 |
108 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
362 |
312 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
558 |
$8K |
| D0330 |
Panoramic radiographic image |
146 |
141 |
$8K |
| D0274 |
Bitewings - four radiographic images |
151 |
145 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
151 |
140 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
2,210 |
1,734 |
$3K |
| D1206 |
Topical application of fluoride varnish |
164 |
142 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
466 |
380 |
$2K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
431 |
351 |
$2K |
| D1110 |
Prophylaxis - adult |
44 |
41 |
$1K |
| 87428 |
|
34 |
18 |
$1K |
| D1120 |
Prophylaxis - child |
54 |
50 |
$1K |
| 82962 |
|
308 |
230 |
$917.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
80 |
59 |
$874.17 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29 |
29 |
$0.00 |
| 99443 |
|
18 |
14 |
$0.00 |