| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,456 |
4,584 |
$1.63M |
| D1351 |
Sealant - per tooth |
35,761 |
9,489 |
$441K |
| D1206 |
Topical application of fluoride varnish |
37,457 |
31,630 |
$368K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,979 |
13,644 |
$336K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,863 |
6,890 |
$272K |
| D0191 |
|
35,774 |
30,068 |
$270K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,399 |
2,843 |
$64K |
| 99215 |
Prolong outpt/office vis |
1,078 |
924 |
$59K |
| 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 |
2,504 |
2,069 |
$56K |
| D1120 |
Prophylaxis - child |
2,995 |
2,644 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,560 |
1,896 |
$35K |
| D0240 |
|
4,047 |
1,882 |
$34K |
| 90832 |
Psychotherapy, 30 minutes with patient |
719 |
544 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,744 |
1,310 |
$15K |
| 0012A |
|
429 |
416 |
$15K |
| 0011A |
|
506 |
485 |
$14K |
| 11721 |
|
1,098 |
983 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
311 |
281 |
$11K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
190 |
172 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
273 |
92 |
$9K |
| 90686 |
|
544 |
509 |
$8K |
| D1110 |
Prophylaxis - adult |
247 |
225 |
$7K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
155 |
150 |
$5K |
| 0064A |
|
191 |
136 |
$5K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
538 |
510 |
$4K |
| 82947 |
|
1,090 |
950 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
351 |
315 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
140 |
$2K |
| 0001A |
|
119 |
114 |
$2K |
| 90677 |
|
17 |
13 |
$2K |
| 11056 |
|
94 |
84 |
$2K |
| D0274 |
Bitewings - four radiographic images |
256 |
170 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
227 |
$2K |
| 0002A |
|
85 |
81 |
$2K |
| 99201 |
|
87 |
85 |
$2K |
| 99205 |
Prolong outpt/office vis |
30 |
28 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
30 |
$2K |
| 81003 |
|
1,007 |
818 |
$1K |
| 90480 |
|
44 |
39 |
$1K |
| 90688 |
|
85 |
78 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
26 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
27 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
37 |
25 |
$1K |
| 90658 |
|
91 |
86 |
$917.94 |
| 90732 |
|
16 |
13 |
$858.34 |
| 81025 |
|
139 |
125 |
$782.13 |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
29 |
$729.60 |
| 0004A |
|
24 |
22 |
$725.04 |
| 90750 |
|
12 |
12 |
$700.00 |
| 86580 |
|
270 |
253 |
$680.43 |
| 11720 |
|
73 |
68 |
$672.37 |
| 0003A |
|
29 |
21 |
$648.72 |
| 81002 |
|
217 |
201 |
$506.70 |
| 90656 |
|
16 |
16 |
$375.44 |
| 90715 |
|
18 |
17 |
$319.11 |
| 96160 |
|
81 |
70 |
$233.60 |
| 90756 |
|
14 |
14 |
$182.30 |
| 83655 |
|
12 |
12 |
$148.23 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
28 |
$86.30 |
| 99000 |
|
25 |
24 |
$78.40 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28 |
26 |
$72.82 |
| 82747 |
|
26 |
20 |
$14.70 |
| 91301 |
|
959 |
905 |
$0.97 |
| 91300 |
|
336 |
271 |
$0.24 |
| 1159F |
|
6,621 |
5,543 |
$0.00 |
| 1160F |
|
6,342 |
5,355 |
$0.00 |
| 3078F |
|
3,557 |
3,068 |
$0.00 |
| 4004F |
|
597 |
530 |
$0.00 |
| 3077F |
|
620 |
540 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
100 |
93 |
$0.00 |
| 3074F |
|
7,413 |
6,349 |
$0.00 |
| 3008F |
|
2,153 |
1,849 |
$0.00 |
| 1125F |
|
704 |
563 |
$0.00 |
| 3079F |
|
3,282 |
2,915 |
$0.00 |
| D1330 |
|
13,654 |
10,200 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
934 |
832 |
$0.00 |
| D0603 |
|
10,962 |
8,200 |
$0.00 |
| 3080F |
|
643 |
552 |
$0.00 |
| D0602 |
|
1,579 |
1,127 |
$0.00 |
| 1126F |
|
48 |
42 |
$0.00 |
| 3075F |
|
238 |
218 |
$0.00 |
| D1353 |
|
138 |
69 |
$0.00 |
| 91306 |
|
175 |
128 |
$0.00 |
| 1170F |
|
105 |
93 |
$0.00 |
| D0601 |
|
54 |
37 |
$0.00 |