| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,095 |
1,474 |
$423K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,631 |
5,276 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
1,408 |
1,347 |
$34K |
| D1120 |
Prophylaxis - child |
2,671 |
2,574 |
$33K |
| D1110 |
Prophylaxis - adult |
1,955 |
1,909 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,854 |
2,720 |
$26K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,107 |
1,096 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,445 |
4,319 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,122 |
1,087 |
$14K |
| D0603 |
|
2,269 |
2,208 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
462 |
444 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
483 |
$11K |
| D0274 |
Bitewings - four radiographic images |
957 |
942 |
$8K |
| 90686 |
|
702 |
689 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
241 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,342 |
1,861 |
$6K |
| D1206 |
Topical application of fluoride varnish |
386 |
386 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
118 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
118 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
270 |
269 |
$3K |
| D1351 |
Sealant - per tooth |
317 |
84 |
$3K |
| 0012A |
|
64 |
64 |
$2K |
| D9910 |
|
678 |
635 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
28 |
28 |
$1K |
| 0011A |
|
53 |
53 |
$1K |
| 99441 |
|
115 |
98 |
$974.46 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$877.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
38 |
$870.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$864.15 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
17 |
17 |
$826.20 |
| 90461 |
|
56 |
54 |
$758.84 |
| D0270 |
|
241 |
241 |
$657.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
12 |
$620.84 |
| 82947 |
|
230 |
218 |
$478.86 |
| 92551 |
|
139 |
139 |
$461.55 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$377.45 |
| 81025 |
|
101 |
100 |
$293.29 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
105 |
101 |
$251.07 |
| D0602 |
|
64 |
61 |
$200.00 |
| D0240 |
|
42 |
14 |
$140.00 |
| 99173 |
|
145 |
144 |
$134.66 |
| 86580 |
|
13 |
12 |
$57.35 |
| D0191 |
|
196 |
162 |
$15.00 |
| 99000 |
|
177 |
167 |
$5.00 |
| 81002 |
|
26 |
26 |
$3.35 |
| D1310 |
|
2,551 |
2,328 |
$0.00 |
| D1330 |
|
4,746 |
4,641 |
$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 |
27 |
25 |
$0.00 |
| 91301 |
|
129 |
127 |
$0.00 |
| 3074F |
|
51 |
50 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
39 |
28 |
$0.00 |
| D0601 |
|
13 |
12 |
$0.00 |
| D9993 |
|
2,561 |
2,413 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,123 |
696 |
$0.00 |
| 4551F |
|
12 |
12 |
$0.00 |
| 3078F |
|
41 |
40 |
$0.00 |