| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,320 |
2,576 |
$381K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,279 |
1,217 |
$22K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
795 |
739 |
$21K |
| 0134A |
|
34 |
30 |
$2K |
| 90651 |
|
74 |
74 |
$2K |
| 90739 |
|
13 |
13 |
$2K |
| 90686 |
|
94 |
92 |
$1K |
| 90715 |
|
54 |
54 |
$377.85 |
| 90480 |
|
13 |
12 |
$284.56 |
| 90656 |
|
13 |
13 |
$268.20 |
| 90713 |
|
12 |
12 |
$14.96 |
| D0220 |
Intraoral - periapical first radiographic image |
885 |
741 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
498 |
434 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
79 |
66 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
27 |
$0.00 |
| D0601 |
|
238 |
167 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
770 |
648 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
157 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
209 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
115 |
98 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
147 |
$0.00 |
| 90619 |
|
39 |
39 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
14 |
$0.00 |