| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,216 |
6,116 |
$1.59M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,338 |
2,073 |
$301.36 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
308 |
284 |
$54.61 |
| 80305 |
|
167 |
149 |
$0.00 |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
14 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
233 |
232 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
317 |
316 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
434 |
334 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
128 |
115 |
$0.00 |
| D0330 |
Panoramic radiographic image |
165 |
162 |
$0.00 |
| D1110 |
Prophylaxis - adult |
633 |
630 |
$0.00 |
| 3078F |
|
318 |
280 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
387 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
36 |
33 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$0.00 |
| 4004F |
|
47 |
44 |
$0.00 |
| 3074F |
|
416 |
363 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
370 |
367 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
270 |
263 |
$0.00 |
| D5899 |
|
74 |
60 |
$0.00 |
| 1036F |
|
627 |
578 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
70 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
588 |
523 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
44 |
$0.00 |
| 3079F |
|
178 |
160 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
27 |
26 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
405 |
325 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
39 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
406 |
405 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
557 |
557 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
73 |
69 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
72 |
$0.00 |
| D2331 |
|
112 |
80 |
$0.00 |
| D2330 |
|
18 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
74 |
69 |
$0.00 |
| 3075F |
|
15 |
14 |
$0.00 |