| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,636 |
14,831 |
$4.03M |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
356 |
324 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,411 |
1,297 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,374 |
1,229 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,137 |
860 |
$2K |
| D1351 |
Sealant - per tooth |
11,584 |
1,713 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
255 |
248 |
$1K |
| D1354 |
|
3,012 |
556 |
$1K |
| D0274 |
Bitewings - four radiographic images |
1,662 |
1,625 |
$1K |
| D1206 |
Topical application of fluoride varnish |
1,955 |
1,905 |
$914.14 |
| 90834 |
Psychotherapy, 45 minutes with patient |
133 |
69 |
$910.18 |
| D0272 |
Bitewings - two radiographic images |
1,671 |
1,634 |
$888.81 |
| D0120 |
Periodic oral evaluation - established patient |
2,138 |
2,088 |
$833.30 |
| D1120 |
Prophylaxis - child |
2,890 |
2,871 |
$714.90 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,177 |
2,124 |
$499.19 |
| G0008 |
Administration of influenza virus vaccine |
37 |
37 |
$485.28 |
| D1110 |
Prophylaxis - adult |
799 |
789 |
$384.97 |
| 90651 |
|
247 |
244 |
$267.38 |
| 99188 |
|
2,706 |
2,673 |
$216.98 |
| 90832 |
Psychotherapy, 30 minutes with patient |
29 |
24 |
$211.28 |
| D7111 |
|
123 |
89 |
$203.02 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,452 |
1,087 |
$195.34 |
| 91300 |
|
43 |
43 |
$195.34 |
| D1330 |
|
71 |
70 |
$192.64 |
| D1352 |
|
418 |
178 |
$135.05 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
743 |
720 |
$110.97 |
| 99000 |
|
30 |
26 |
$106.68 |
| D0330 |
Panoramic radiographic image |
1,940 |
1,891 |
$73.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
397 |
392 |
$63.33 |
| 36415 |
Collection of venous blood by venipuncture |
28 |
25 |
$56.42 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
371 |
365 |
$37.01 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
25 |
$0.00 |
| 90744 |
|
50 |
50 |
$0.00 |
| D3120 |
|
15 |
14 |
$0.00 |
| D0602 |
|
65 |
65 |
$0.00 |
| D0273 |
|
28 |
28 |
$0.00 |
| D0603 |
|
349 |
346 |
$0.00 |
| 90656 |
|
55 |
55 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
17 |
17 |
$0.00 |
| 90686 |
|
42 |
42 |
$0.00 |
| 90619 |
|
26 |
26 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| 90461 |
|
97 |
97 |
$0.00 |
| 90715 |
|
271 |
270 |
$0.00 |
| 90707 |
|
87 |
86 |
$0.00 |
| D0190 |
|
91 |
91 |
$0.00 |
| 90713 |
|
337 |
333 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
105 |
104 |
$0.00 |
| 90633 |
|
133 |
131 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
34 |
34 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
13 |
$0.00 |
| 90734 |
|
12 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$0.00 |