| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
31,375 |
26,949 |
$6.48M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,838 |
8,315 |
$215K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,648 |
7,153 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
330 |
144 |
$24K |
| 90834 |
Psychotherapy, 45 minutes with patient |
444 |
260 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
56 |
$9K |
| 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 |
286 |
238 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
26 |
$6K |
| 99406 |
|
332 |
322 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
117 |
116 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
225 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
95 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
122 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$744.40 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
42 |
42 |
$362.88 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$313.56 |
| 99442 |
|
12 |
12 |
$211.60 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$176.40 |
| D0274 |
Bitewings - four radiographic images |
373 |
373 |
$0.00 |
| D0330 |
Panoramic radiographic image |
437 |
437 |
$0.00 |
| D1120 |
Prophylaxis - child |
391 |
391 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
366 |
344 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
119 |
119 |
$0.00 |
| D1110 |
Prophylaxis - adult |
213 |
213 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
14 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
81 |
81 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
50 |
49 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
271 |
271 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
498 |
498 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
823 |
823 |
$0.00 |
| 87428 |
|
102 |
101 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
28 |
28 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
12 |
12 |
$0.00 |