| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,381 |
6,199 |
$1.59M |
| D0120 |
Periodic oral evaluation - established patient |
4,446 |
4,345 |
$64K |
| D1120 |
Prophylaxis - child |
3,614 |
3,528 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,048 |
1,985 |
$44K |
| D1110 |
Prophylaxis - adult |
2,334 |
2,266 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
5,425 |
5,293 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
440 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,120 |
1,086 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,858 |
1,815 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,357 |
1,354 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
869 |
854 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,342 |
3,925 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
438 |
433 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,669 |
3,077 |
$4K |
| D9310 |
|
221 |
221 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
54 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
111 |
111 |
$2K |
| D0272 |
Bitewings - two radiographic images |
302 |
302 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,358 |
1,062 |
$1K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$756.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
582 |
552 |
$366.85 |
| D1351 |
Sealant - per tooth |
35 |
14 |
$350.00 |
| 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 |
53 |
44 |
$133.67 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
137 |
137 |
$82.28 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
534 |
527 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
19 |
15 |
$0.00 |
| 99173 |
|
154 |
154 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
136 |
136 |
$0.00 |
| 90633 |
|
90 |
90 |
$0.00 |
| H1000 |
Prenatal care, at-risk assessment |
15 |
13 |
$0.00 |
| 90715 |
|
79 |
79 |
$0.00 |
| 90713 |
|
54 |
54 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
71 |
69 |
$0.00 |
| D1330 |
|
2,558 |
2,413 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
880 |
842 |
$0.00 |
| 99385 |
|
106 |
102 |
$0.00 |
| 92551 |
|
112 |
112 |
$0.00 |
| 97802 |
|
45 |
42 |
$0.00 |
| 90686 |
|
73 |
73 |
$0.00 |
| 90716 |
|
54 |
54 |
$0.00 |
| 90744 |
|
58 |
58 |
$0.00 |
| 82962 |
|
218 |
211 |
$0.00 |
| 99386 |
|
25 |
25 |
$0.00 |