| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,309 |
17,342 |
$1.71M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,870 |
5,429 |
$193K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,000 |
2,182 |
$123K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,528 |
556 |
$37K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,692 |
1,432 |
$35K |
| D1110 |
Prophylaxis - adult |
2,264 |
1,583 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,305 |
1,642 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
2,591 |
1,775 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,473 |
841 |
$14K |
| D0330 |
Panoramic radiographic image |
1,842 |
1,408 |
$13K |
| 90832 |
Psychotherapy, 30 minutes with patient |
471 |
209 |
$9K |
| D0274 |
Bitewings - four radiographic images |
2,015 |
1,442 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,735 |
1,145 |
$9K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
434 |
248 |
$7K |
| D1120 |
Prophylaxis - child |
1,046 |
692 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
89 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
279 |
137 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
392 |
235 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
1,001 |
729 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
128 |
88 |
$3K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
88 |
40 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
27 |
$2K |
| D1351 |
Sealant - per tooth |
177 |
48 |
$2K |
| 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 |
95 |
71 |
$1K |
| Q3014 |
Telehealth originating site facility fee |
103 |
64 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
709 |
464 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
25 |
14 |
$819.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
453 |
163 |
$687.75 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
141 |
96 |
$650.00 |
| 90686 |
|
123 |
96 |
$574.12 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
87 |
47 |
$549.65 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
64 |
38 |
$489.57 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
13 |
$369.54 |
| D0272 |
Bitewings - two radiographic images |
105 |
71 |
$260.00 |
| 99173 |
|
192 |
108 |
$238.23 |
| 3074F |
|
559 |
530 |
$0.00 |
| 3079F |
|
238 |
228 |
$0.00 |
| 3008F |
|
499 |
366 |
$0.00 |
| 4000F |
|
18 |
13 |
$0.00 |
| 1034F |
|
365 |
251 |
$0.00 |
| 1000F |
|
938 |
670 |
$0.00 |
| 1036F |
|
514 |
369 |
$0.00 |
| D1320 |
|
14 |
14 |
$0.00 |
| 3080F |
|
14 |
13 |
$0.00 |
| 1159F |
|
819 |
778 |
$0.00 |
| 3078F |
|
340 |
322 |
$0.00 |
| 3725F |
|
302 |
242 |
$0.00 |
| 3077F |
|
16 |
13 |
$0.00 |