| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,128 |
16,129 |
$1.44M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,206 |
4,826 |
$189K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,477 |
1,398 |
$80K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,874 |
1,336 |
$64K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
7,630 |
1,782 |
$55K |
| D1110 |
Prophylaxis - adult |
2,535 |
1,586 |
$42K |
| D0330 |
Panoramic radiographic image |
1,410 |
857 |
$31K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,059 |
1,044 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,005 |
1,223 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,277 |
859 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,824 |
1,084 |
$16K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
583 |
317 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,924 |
1,216 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
80 |
$9K |
| D1206 |
Topical application of fluoride varnish |
616 |
398 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
277 |
147 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
37 |
$5K |
| 90686 |
|
839 |
515 |
$5K |
| D1120 |
Prophylaxis - child |
378 |
253 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
476 |
294 |
$4K |
| 92551 |
|
1,349 |
762 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,173 |
663 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
188 |
113 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
28 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
668 |
465 |
$3K |
| 36416 |
|
1,410 |
802 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
52 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
48 |
26 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
64 |
37 |
$2K |
| 90670 |
|
343 |
243 |
$1K |
| 99173 |
|
871 |
482 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
46 |
$806.06 |
| 85018 |
|
672 |
374 |
$691.53 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
12 |
$444.36 |
| 90688 |
|
108 |
70 |
$434.39 |
| 90715 |
|
35 |
24 |
$369.51 |
| 36415 |
Collection of venous blood by venipuncture |
262 |
161 |
$278.51 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
42 |
15 |
$263.09 |
| 90656 |
|
30 |
30 |
$200.95 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25 |
13 |
$161.82 |
| 3074F |
|
311 |
249 |
$120.00 |
| 90716 |
|
107 |
83 |
$104.87 |
| 3079F |
|
119 |
93 |
$100.00 |
| 3078F |
|
188 |
161 |
$85.00 |
| 3008F |
|
127 |
116 |
$80.00 |
| 81002 |
|
95 |
59 |
$65.38 |
| 90707 |
|
95 |
71 |
$57.67 |
| D1351 |
Sealant - per tooth |
153 |
143 |
$44.00 |
| 87210 |
|
21 |
13 |
$35.18 |
| 3075F |
|
20 |
17 |
$30.00 |
| 3044F |
|
19 |
12 |
$0.08 |
| 90685 |
|
57 |
43 |
$0.04 |
| 90698 |
|
148 |
90 |
$0.01 |
| 90633 |
|
165 |
117 |
$0.01 |
| 1036F |
|
2,264 |
1,226 |
$0.00 |
| 90744 |
|
65 |
38 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
387 |
210 |
$0.00 |
| 3351F |
|
17 |
15 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
57 |
$0.00 |
| G8756 |
No documentation of blood pressure measurement, reason not given |
68 |
38 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
43 |
40 |
$0.00 |
| 4004F |
|
1,564 |
871 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
345 |
183 |
$0.00 |
| 90734 |
|
24 |
14 |
$0.00 |
| 1160F |
|
236 |
194 |
$0.00 |