| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,709 |
19,077 |
$1.85M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,854 |
3,218 |
$125K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,299 |
795 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,690 |
1,346 |
$35K |
| D0330 |
Panoramic radiographic image |
3,083 |
2,834 |
$28K |
| D1351 |
Sealant - per tooth |
1,187 |
368 |
$22K |
| D1110 |
Prophylaxis - adult |
3,758 |
3,468 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,080 |
2,805 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,570 |
1,181 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
4,739 |
4,367 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,431 |
1,121 |
$15K |
| D1120 |
Prophylaxis - child |
2,381 |
2,214 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,740 |
4,425 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
2,779 |
2,465 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
430 |
284 |
$12K |
| D0274 |
Bitewings - four radiographic images |
3,181 |
2,932 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
6,879 |
6,172 |
$5K |
| D2140 |
|
80 |
62 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,519 |
3,986 |
$3K |
| Q3014 |
Telehealth originating site facility fee |
776 |
431 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
140 |
102 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
358 |
129 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
940 |
840 |
$2K |
| V2020 |
Frames, purchases |
80 |
80 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
53 |
53 |
$1K |
| 90756 |
|
69 |
49 |
$932.12 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
90 |
64 |
$864.54 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
39 |
$780.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
100 |
23 |
$759.75 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
21 |
12 |
$678.29 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
25 |
$540.48 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
13 |
$506.09 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$414.70 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$377.00 |
| 92015 |
Determination of refractive state |
60 |
43 |
$374.94 |
| 92551 |
|
123 |
71 |
$327.04 |
| 90688 |
|
23 |
14 |
$202.10 |
| 90686 |
|
21 |
15 |
$141.96 |
| 99173 |
|
59 |
34 |
$65.54 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
181 |
162 |
$0.00 |
| 3074F |
|
3,134 |
2,827 |
$0.00 |
| 3079F |
|
761 |
697 |
$0.00 |
| 1036F |
|
2,634 |
2,301 |
$0.00 |
| 3008F |
|
594 |
519 |
$0.00 |
| 3075F |
|
67 |
63 |
$0.00 |
| 2001F |
|
101 |
93 |
$0.00 |
| 3048F |
|
128 |
110 |
$0.00 |
| 1034F |
|
27 |
25 |
$0.00 |
| 4000F |
|
14 |
12 |
$0.00 |
| 4004F |
|
1,303 |
1,177 |
$0.00 |
| 3078F |
|
2,635 |
2,411 |
$0.00 |
| 1159F |
|
607 |
534 |
$0.00 |
| 1160F |
|
607 |
534 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
440 |
385 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
64 |
59 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
14 |
12 |
$0.00 |