| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
53,657 |
47,616 |
$8.76M |
| 3078F |
|
11,848 |
11,323 |
$15K |
| 3074F |
|
14,110 |
13,437 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,143 |
13,812 |
$13K |
| 3079F |
|
5,414 |
5,220 |
$11K |
| 3077F |
|
1,652 |
1,569 |
$7K |
| 3075F |
|
2,289 |
2,206 |
$7K |
| 3080F |
|
789 |
754 |
$3K |
| D1110 |
Prophylaxis - adult |
1,070 |
1,032 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
968 |
931 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,224 |
1,157 |
$1K |
| 0071A |
|
26 |
26 |
$1K |
| D1120 |
Prophylaxis - child |
1,894 |
1,881 |
$800.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
137 |
$780.00 |
| 3725F |
|
5,950 |
5,690 |
$664.49 |
| 90686 |
|
1,373 |
1,353 |
$555.28 |
| D0274 |
Bitewings - four radiographic images |
834 |
802 |
$553.00 |
| D1206 |
Topical application of fluoride varnish |
2,329 |
2,314 |
$522.00 |
| 0013A |
|
13 |
13 |
$520.00 |
| 0072A |
|
13 |
13 |
$520.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,655 |
8,202 |
$451.70 |
| 97803 |
|
440 |
412 |
$290.80 |
| D1351 |
Sealant - per tooth |
451 |
92 |
$275.00 |
| 0011A |
|
15 |
14 |
$240.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,426 |
1,360 |
$208.00 |
| 0012A |
|
13 |
12 |
$200.00 |
| D0272 |
Bitewings - two radiographic images |
151 |
145 |
$192.00 |
| D0330 |
Panoramic radiographic image |
190 |
177 |
$185.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
306 |
$175.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,296 |
1,261 |
$168.09 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
91 |
88 |
$162.75 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
309 |
$150.00 |
| 96127 |
|
1,979 |
1,889 |
$98.02 |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
262 |
$90.00 |
| 0004A |
|
13 |
13 |
$80.00 |
| 0124A |
|
34 |
34 |
$80.00 |
| 99173 |
|
1,593 |
1,587 |
$57.67 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
558 |
556 |
$40.00 |
| 90658 |
|
59 |
59 |
$32.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
382 |
315 |
$24.00 |
| D1310 |
|
813 |
800 |
$10.87 |
| 92551 |
|
757 |
755 |
$7.20 |
| D1330 |
|
2,909 |
2,855 |
$0.02 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,225 |
1,211 |
$0.01 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
209 |
208 |
$0.00 |
| 1159F |
|
14,413 |
13,539 |
$0.00 |
| 92552 |
|
496 |
492 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
99 |
99 |
$0.00 |
| 96160 |
|
344 |
335 |
$0.00 |
| 1160F |
|
15,394 |
14,472 |
$0.00 |
| 90461 |
|
377 |
371 |
$0.00 |
| D0270 |
|
178 |
175 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
124 |
120 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
102 |
102 |
$0.00 |
| 80305 |
|
286 |
227 |
$0.00 |
| D0190 |
|
675 |
671 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
76 |
71 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
12 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
56 |
56 |
$0.00 |
| 90715 |
|
29 |
29 |
$0.00 |
| 99408 |
|
93 |
89 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
39 |
37 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
18 |
18 |
$0.00 |
| 1036F |
|
12,332 |
11,493 |
$0.00 |
| 90674 |
|
265 |
194 |
$0.00 |
| 3008F |
|
20,943 |
19,545 |
$0.00 |
| 1034F |
|
3,000 |
2,683 |
$0.00 |
| D0603 |
|
1,378 |
1,371 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
37 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
13 |
$0.00 |
| 1000F |
|
474 |
436 |
$0.00 |
| 4000F |
|
29 |
29 |
$0.00 |
| G9226 |
Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
37 |
37 |
$0.00 |
| 91307 |
|
33 |
32 |
$0.00 |
| 97802 |
|
51 |
48 |
$0.00 |
| 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 |
25 |
12 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
52 |
49 |
$0.00 |
| 90480 |
|
12 |
12 |
$0.00 |
| 1035F |
|
15 |
12 |
$0.00 |