| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,875 |
4,927 |
$1.24M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
23,578 |
19,048 |
$522K |
| D0210 |
Intraoral - complete series of radiographic images |
2,093 |
2,082 |
$53K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,751 |
1,572 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,294 |
3,253 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
3,566 |
3,495 |
$42K |
| D1110 |
Prophylaxis - adult |
2,629 |
2,590 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,726 |
1,714 |
$38K |
| D1120 |
Prophylaxis - child |
2,892 |
2,851 |
$37K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
632 |
609 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,547 |
1,490 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
314 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
219 |
219 |
$13K |
| D1351 |
Sealant - per tooth |
1,304 |
295 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
3,841 |
3,581 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,003 |
937 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
261 |
223 |
$10K |
| 90658 |
|
570 |
553 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
409 |
366 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,442 |
1,622 |
$8K |
| 81025 |
|
3,985 |
3,396 |
$8K |
| D0190 |
|
7,332 |
6,328 |
$7K |
| D0601 |
|
698 |
698 |
$7K |
| 0011A |
|
182 |
180 |
$7K |
| 88142 |
|
391 |
350 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
148 |
$6K |
| D9110 |
|
479 |
471 |
$5K |
| 0012A |
|
108 |
108 |
$4K |
| D0274 |
Bitewings - four radiographic images |
706 |
691 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
75 |
75 |
$4K |
| 81002 |
|
11,788 |
8,320 |
$3K |
| D4355 |
|
76 |
76 |
$3K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
4,297 |
3,918 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
54 |
$3K |
| D2140 |
|
90 |
78 |
$3K |
| D0603 |
|
267 |
267 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
73 |
$3K |
| 0002A |
|
80 |
71 |
$2K |
| 0001A |
|
63 |
53 |
$2K |
| D0602 |
|
143 |
142 |
$1K |
| 0071A |
|
44 |
34 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
68 |
68 |
$990.00 |
| D0270 |
|
310 |
305 |
$914.00 |
| D9310 |
|
38 |
38 |
$745.26 |
| 0003A |
|
20 |
20 |
$718.97 |
| 0072A |
|
17 |
15 |
$616.41 |
| 87590 |
|
390 |
318 |
$589.56 |
| 59025 |
Fetal non-stress test |
21 |
12 |
$576.82 |
| 90686 |
|
31 |
30 |
$573.52 |
| 90715 |
|
12 |
12 |
$571.00 |
| 82962 |
|
1,087 |
955 |
$530.05 |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
45 |
$410.00 |
| 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 |
95 |
94 |
$403.63 |
| 97803 |
|
1,312 |
1,187 |
$368.85 |
| 99397 |
|
12 |
12 |
$309.25 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
210 |
189 |
$165.16 |
| 97802 |
|
709 |
610 |
$145.76 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$145.00 |
| D9430 |
|
141 |
101 |
$133.00 |
| 92551 |
|
25 |
25 |
$58.28 |
| 99173 |
|
25 |
25 |
$17.56 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
12 |
12 |
$17.55 |
| 87490 |
|
497 |
461 |
$15.00 |
| 3074F |
|
234 |
233 |
$0.00 |
| 99000 |
|
1,065 |
839 |
$0.00 |
| D1310 |
|
502 |
477 |
$0.00 |
| D1330 |
|
2,834 |
2,695 |
$0.00 |
| 3075F |
|
181 |
179 |
$0.00 |
| 3044F |
|
12 |
12 |
$0.00 |
| 1170F |
|
12 |
12 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| 3078F |
|
267 |
265 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
178 |
178 |
$0.00 |
| 0502F |
|
90 |
58 |
$0.00 |
| 90750 |
|
75 |
74 |
$0.00 |
| D0191 |
|
48 |
46 |
$0.00 |