| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
56,873 |
49,350 |
$14.37M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,336 |
10,483 |
$655K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,250 |
12,944 |
$641K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,435 |
1,052 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,605 |
2,468 |
$84K |
| D1206 |
Topical application of fluoride varnish |
4,108 |
3,952 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,292 |
2,057 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,544 |
637 |
$60K |
| D1110 |
Prophylaxis - adult |
1,787 |
1,702 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,223 |
1,141 |
$40K |
| D4910 |
|
1,421 |
1,353 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
597 |
425 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,572 |
2,355 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,759 |
1,703 |
$21K |
| D0330 |
Panoramic radiographic image |
557 |
538 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
130 |
$16K |
| 99215 |
Prolong outpt/office vis |
340 |
303 |
$16K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
144 |
131 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
431 |
348 |
$13K |
| D4341 |
|
365 |
201 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
280 |
243 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
111 |
76 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
49 |
48 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
117 |
113 |
$4K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
42 |
41 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
88 |
72 |
$3K |
| 90686 |
|
325 |
323 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
199 |
196 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
14 |
$2K |
| G0071 |
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
14 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
637 |
301 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$1K |
| 90682 |
|
12 |
12 |
$507.58 |
| D4342 |
|
24 |
13 |
$213.69 |
| 99442 |
|
12 |
12 |
$189.94 |
| 90688 |
|
17 |
17 |
$144.34 |
| D0270 |
|
14 |
13 |
$121.44 |
| D1354 |
|
29 |
13 |
$87.00 |
| D0460 |
|
27 |
14 |
$4.85 |