| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,157 |
21,579 |
$1.92M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,521 |
8,748 |
$307K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,427 |
6,722 |
$301K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,520 |
1,124 |
$47K |
| D1110 |
Prophylaxis - adult |
3,587 |
2,311 |
$39K |
| D0330 |
Panoramic radiographic image |
2,085 |
1,375 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,285 |
711 |
$20K |
| 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 |
698 |
618 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
2,521 |
1,608 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
808 |
441 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
2,256 |
1,415 |
$12K |
| D0274 |
Bitewings - four radiographic images |
2,581 |
1,728 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,454 |
965 |
$11K |
| D1120 |
Prophylaxis - child |
1,586 |
984 |
$11K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
157 |
87 |
$9K |
| 99442 |
|
714 |
333 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,196 |
779 |
$6K |
| D1206 |
Topical application of fluoride varnish |
833 |
475 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,617 |
1,668 |
$4K |
| Q3014 |
Telehealth originating site facility fee |
524 |
259 |
$4K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
154 |
76 |
$3K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
59 |
31 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
528 |
278 |
$3K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
729 |
480 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
87 |
55 |
$2K |
| D1351 |
Sealant - per tooth |
149 |
40 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
29 |
$910.00 |
| 36415 |
Collection of venous blood by venipuncture |
927 |
512 |
$908.33 |
| D0272 |
Bitewings - two radiographic images |
343 |
228 |
$810.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
70 |
49 |
$790.27 |
| 0011A |
|
20 |
19 |
$546.84 |
| 0012A |
|
15 |
15 |
$545.02 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
70 |
38 |
$530.35 |
| 90686 |
|
81 |
52 |
$513.64 |
| 90674 |
|
41 |
28 |
$366.78 |
| 99406 |
|
55 |
31 |
$220.65 |
| 90756 |
|
30 |
14 |
$208.53 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25 |
12 |
$162.44 |
| D0270 |
|
107 |
69 |
$150.00 |
| 99441 |
|
25 |
12 |
$142.09 |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
29 |
$90.00 |
| 91301 |
|
39 |
39 |
$0.36 |
| 3074F |
|
380 |
235 |
$0.00 |
| D1330 |
|
1,084 |
829 |
$0.00 |
| 3080F |
|
40 |
26 |
$0.00 |
| D0603 |
|
81 |
80 |
$0.00 |
| 3079F |
|
255 |
169 |
$0.00 |
| D0601 |
|
75 |
65 |
$0.00 |
| 1160F |
|
3,065 |
1,735 |
$0.00 |
| 3078F |
|
240 |
153 |
$0.00 |
| 3077F |
|
163 |
102 |
$0.00 |
| 1159F |
|
33 |
17 |
$0.00 |
| D1999 |
|
1,217 |
891 |
$0.00 |