| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
58,508 |
40,337 |
$8.14M |
| D0999 |
Unspecified diagnostic procedure, by report |
11,125 |
9,640 |
$1.21M |
| 0502F |
|
23,089 |
13,637 |
$2K |
| 0503F |
|
3,719 |
2,994 |
$2K |
| 96127 |
|
33,999 |
24,325 |
$1K |
| 81025 |
|
19,297 |
15,973 |
$497.58 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,412 |
9,613 |
$332.00 |
| D1120 |
Prophylaxis - child |
2,654 |
2,566 |
$328.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,142 |
2,049 |
$305.92 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,812 |
2,722 |
$291.74 |
| 36415 |
Collection of venous blood by venipuncture |
10,144 |
8,148 |
$284.00 |
| 81002 |
|
11,818 |
8,828 |
$269.40 |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,786 |
$240.20 |
| D1206 |
Topical application of fluoride varnish |
2,008 |
1,946 |
$208.00 |
| D0274 |
Bitewings - four radiographic images |
2,293 |
2,235 |
$156.48 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
10,083 |
8,510 |
$138.00 |
| D0272 |
Bitewings - two radiographic images |
2,553 |
2,447 |
$121.99 |
| D0220 |
Intraoral - periapical first radiographic image |
4,482 |
4,225 |
$109.34 |
| 0500F |
|
2,978 |
2,758 |
$65.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,532 |
3,344 |
$59.32 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
214 |
$56.82 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,403 |
2,023 |
$54.00 |
| D1110 |
Prophylaxis - adult |
239 |
234 |
$50.80 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,061 |
905 |
$41.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
247 |
$36.40 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,547 |
1,420 |
$27.00 |
| 90686 |
|
259 |
224 |
$18.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
797 |
704 |
$13.00 |
| G0008 |
Administration of influenza virus vaccine |
41 |
34 |
$10.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
239 |
222 |
$5.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
121 |
110 |
$0.82 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
71 |
63 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
508 |
381 |
$0.00 |
| D0270 |
|
89 |
88 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
57 |
53 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
120 |
107 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
672 |
563 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,846 |
1,416 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
117 |
107 |
$0.00 |
| D1351 |
Sealant - per tooth |
43 |
16 |
$0.00 |
| 99385 |
|
13 |
13 |
$0.00 |