| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,702 |
2,840 |
$170K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
732 |
264 |
$27K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,188 |
973 |
$19K |
| D1120 |
Prophylaxis - child |
1,519 |
1,107 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,803 |
1,326 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
839 |
625 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,075 |
790 |
$10K |
| D2140 |
|
321 |
156 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
304 |
265 |
$7K |
| D1351 |
Sealant - per tooth |
608 |
154 |
$6K |
| D0272 |
Bitewings - two radiographic images |
807 |
585 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
252 |
223 |
$4K |
| D0274 |
Bitewings - four radiographic images |
226 |
182 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
350 |
330 |
$1K |
| 96127 |
|
974 |
839 |
$995.14 |
| 92015 |
Determination of refractive state |
518 |
487 |
$958.18 |
| 36415 |
Collection of venous blood by venipuncture |
944 |
825 |
$817.48 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
24 |
$745.45 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
81 |
$541.08 |
| 87205 |
|
298 |
259 |
$509.14 |
| 87210 |
|
238 |
209 |
$401.96 |
| 92551 |
|
77 |
61 |
$201.18 |
| 96160 |
|
208 |
173 |
$165.32 |
| 85018 |
|
139 |
107 |
$127.02 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
12 |
$122.30 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
28 |
27 |
$108.85 |
| H1002 |
Prenatal care, at risk enhanced service; care coordination |
33 |
25 |
$72.60 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
17 |
15 |
$40.10 |
| 83655 |
|
17 |
15 |
$12.46 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
62 |
$0.00 |
| D1110 |
Prophylaxis - adult |
82 |
79 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
59 |
55 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
29 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
12 |
$0.00 |