| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
68,280 |
60,415 |
$16.58M |
| 00003 |
Internal/system code - not a standard HCPCS code |
11,490 |
7,333 |
$3.30M |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
7,381 |
4,843 |
$98K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25,516 |
15,644 |
$82K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,366 |
933 |
$74K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,061 |
7,273 |
$71K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,652 |
811 |
$70K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
6,323 |
4,676 |
$65K |
| D1351 |
Sealant - per tooth |
2,301 |
655 |
$62K |
| D1120 |
Prophylaxis - child |
2,087 |
1,327 |
$58K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,591 |
3,394 |
$45K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,922 |
3,052 |
$45K |
| 90791 |
Psychiatric diagnostic evaluation |
447 |
287 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,357 |
1,455 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,580 |
933 |
$26K |
| 92015 |
Determination of refractive state |
4,549 |
3,019 |
$24K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
612 |
532 |
$24K |
| 90686 |
|
8,863 |
6,272 |
$20K |
| 83655 |
|
2,295 |
1,583 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,720 |
1,048 |
$17K |
| 92551 |
|
10,823 |
7,748 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,069 |
703 |
$14K |
| 99383 |
|
314 |
252 |
$12K |
| 90832 |
Psychotherapy, 30 minutes with patient |
213 |
139 |
$11K |
| 90670 |
|
3,106 |
2,281 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
254 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,097 |
3,123 |
$9K |
| 90633 |
|
3,020 |
2,201 |
$8K |
| 90651 |
|
2,803 |
2,003 |
$8K |
| 90647 |
|
2,212 |
1,639 |
$7K |
| 90723 |
|
1,886 |
1,423 |
$7K |
| 90680 |
|
2,538 |
1,823 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,994 |
339 |
$6K |
| 90734 |
|
1,218 |
936 |
$5K |
| 99382 |
|
143 |
105 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
132 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
208 |
$5K |
| 99381 |
|
579 |
477 |
$4K |
| 90688 |
|
368 |
368 |
$4K |
| 90716 |
|
1,465 |
1,094 |
$3K |
| D1352 |
|
161 |
84 |
$3K |
| 90620 |
|
1,336 |
916 |
$3K |
| 99384 |
|
53 |
48 |
$3K |
| 90710 |
|
972 |
707 |
$3K |
| 90696 |
|
749 |
591 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
206 |
137 |
$3K |
| 90715 |
|
1,328 |
966 |
$3K |
| 90707 |
|
1,129 |
800 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,010 |
5,891 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
318 |
257 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
128 |
99 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,079 |
4,307 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
256 |
175 |
$2K |
| 90700 |
|
656 |
469 |
$2K |
| 90685 |
|
86 |
86 |
$984.33 |
| 85018 |
|
2,737 |
2,191 |
$870.31 |
| 99215 |
Prolong outpt/office vis |
168 |
116 |
$870.13 |
| 87428 |
|
23 |
12 |
$635.90 |
| D9430 |
|
39 |
24 |
$572.00 |
| 92081 |
|
12 |
12 |
$481.68 |
| D0240 |
|
35 |
12 |
$299.00 |
| 90671 |
|
611 |
546 |
$204.57 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
69 |
39 |
$198.86 |
| 86580 |
|
194 |
192 |
$185.85 |
| D0272 |
Bitewings - two radiographic images |
27 |
15 |
$182.00 |
| 88720 |
|
38 |
26 |
$95.22 |
| 90480 |
|
396 |
369 |
$40.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
5,613 |
4,424 |
$30.00 |
| 81002 |
|
124 |
94 |
$15.84 |
| 90697 |
|
1,033 |
666 |
$11.07 |
| 90656 |
|
597 |
475 |
$0.00 |
| 3008F |
|
563 |
549 |
$0.00 |
| 90619 |
|
624 |
571 |
$0.00 |
| D1330 |
|
910 |
905 |
$0.00 |
| D1310 |
|
877 |
872 |
$0.00 |
| D0603 |
|
735 |
729 |
$0.00 |
| 91319 |
|
115 |
107 |
$0.00 |
| 90744 |
|
143 |
134 |
$0.00 |
| 90474 |
|
701 |
572 |
$0.00 |
| 2001F |
|
205 |
204 |
$0.00 |
| 2010F |
|
219 |
218 |
$0.00 |
| 96380 |
|
42 |
39 |
$0.00 |
| 4037F |
|
133 |
133 |
$0.00 |
| 1036F |
|
18 |
16 |
$0.00 |
| 91318 |
|
42 |
41 |
$0.00 |
| 1126F |
|
46 |
46 |
$0.00 |
| 3074F |
|
100 |
99 |
$0.00 |
| 90381 |
|
38 |
35 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |
| 90461 |
|
2,746 |
2,086 |
$0.00 |
| 90473 |
|
490 |
416 |
$0.00 |
| 1160F |
|
70 |
69 |
$0.00 |
| 99173 |
|
4,141 |
4,130 |
$0.00 |
| 1159F |
|
70 |
69 |
$0.00 |
| 91320 |
|
131 |
118 |
$0.00 |
| 90713 |
|
165 |
148 |
$0.00 |
| 4040F |
|
129 |
121 |
$0.00 |
| 4274F |
|
336 |
324 |
$0.00 |
| D1110 |
Prophylaxis - adult |
32 |
32 |
$0.00 |
| 3078F |
|
100 |
99 |
$0.00 |