| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
238,213 |
222,544 |
$54.99M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
104,773 |
99,331 |
$449K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
8,160 |
8,154 |
$248K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,548 |
1,212 |
$151K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,937 |
5,928 |
$147K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
11,512 |
11,509 |
$90K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
10,491 |
10,366 |
$84K |
| D9999 |
Unspecified adjunctive procedure, by report |
270 |
264 |
$83K |
| V2020 |
Frames, purchases |
8,190 |
8,182 |
$82K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
32,462 |
32,368 |
$81K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,015 |
6,907 |
$69K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
11,996 |
11,995 |
$69K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
17,906 |
17,885 |
$65K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
7,956 |
7,953 |
$56K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,863 |
1,860 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,225 |
1,164 |
$33K |
| 0002A |
|
737 |
736 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
425 |
374 |
$26K |
| 0071A |
|
615 |
614 |
$25K |
| 0001A |
|
613 |
612 |
$25K |
| 0072A |
|
556 |
556 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,722 |
5,722 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,143 |
3,143 |
$15K |
| 99188 |
|
1,973 |
1,973 |
$15K |
| 97802 |
|
439 |
423 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
359 |
356 |
$7K |
| 87428 |
|
3,029 |
3,019 |
$6K |
| D1120 |
Prophylaxis - child |
12,606 |
12,593 |
$5K |
| 90474 |
|
2,377 |
2,375 |
$5K |
| 90832 |
Psychotherapy, 30 minutes with patient |
173 |
136 |
$5K |
| 97803 |
|
379 |
378 |
$4K |
| 92015 |
Determination of refractive state |
8,606 |
8,606 |
$4K |
| D1206 |
Topical application of fluoride varnish |
14,789 |
14,772 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
28 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
12,160 |
12,160 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
162 |
162 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
76 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
101 |
101 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
348 |
348 |
$2K |
| 0012A |
|
53 |
53 |
$2K |
| 0003A |
|
48 |
48 |
$2K |
| D0274 |
Bitewings - four radiographic images |
3,832 |
3,832 |
$2K |
| 0011A |
|
76 |
76 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,050 |
1,040 |
$2K |
| D1110 |
Prophylaxis - adult |
2,166 |
2,166 |
$1K |
| 90715 |
|
805 |
805 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,265 |
2,264 |
$586.88 |
| 90656 |
|
122 |
122 |
$523.25 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,614 |
1,609 |
$494.00 |
| 0081A |
|
12 |
12 |
$480.00 |
| 0111A |
|
12 |
12 |
$480.00 |
| 96381 |
|
49 |
49 |
$339.03 |
| 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 |
14 |
14 |
$302.40 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
373 |
373 |
$295.29 |
| 90686 |
|
9,117 |
9,116 |
$251.16 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$213.36 |
| 0121A |
|
47 |
47 |
$200.00 |
| 99381 |
|
1,044 |
1,040 |
$191.38 |
| 99215 |
Prolong outpt/office vis |
490 |
489 |
$161.13 |
| 90480 |
|
65 |
65 |
$160.00 |
| 0141A |
|
12 |
12 |
$120.00 |
| 88720 |
|
1,233 |
1,045 |
$94.93 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
26 |
25 |
$86.81 |
| 81025 |
|
529 |
527 |
$86.51 |
| D1354 |
|
96 |
51 |
$74.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
811 |
$60.99 |
| D0330 |
Panoramic radiographic image |
1,269 |
1,269 |
$48.77 |
| D0272 |
Bitewings - two radiographic images |
1,688 |
1,688 |
$36.60 |
| D1351 |
Sealant - per tooth |
4,711 |
1,360 |
$24.40 |
| 90633 |
|
3,242 |
3,242 |
$0.11 |
| 90651 |
|
4,672 |
4,670 |
$0.00 |
| 1111F |
|
5,864 |
5,620 |
$0.00 |
| 3008F |
|
9,384 |
9,016 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,314 |
8,304 |
$0.00 |
| 3074F |
|
6,078 |
5,889 |
$0.00 |
| 90647 |
|
6,047 |
6,043 |
$0.00 |
| 90723 |
|
6,154 |
6,149 |
$0.00 |
| 90674 |
|
5,302 |
5,302 |
$0.00 |
| 90716 |
|
749 |
749 |
$0.00 |
| 90620 |
|
736 |
736 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
77 |
77 |
$0.00 |
| 87807 |
|
298 |
298 |
$0.00 |
| 90677 |
|
427 |
427 |
$0.00 |
| 90696 |
|
180 |
180 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
140 |
140 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
13 |
$0.00 |
| 99384 |
|
12 |
12 |
$0.00 |
| 90381 |
|
13 |
13 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
31 |
31 |
$0.00 |
| 90671 |
|
3,002 |
3,000 |
$0.00 |
| 90707 |
|
634 |
634 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
668 |
668 |
$0.00 |
| 90734 |
|
2,328 |
2,326 |
$0.00 |
| 90681 |
|
3,235 |
3,233 |
$0.00 |
| 90661 |
|
1,415 |
1,415 |
$0.00 |
| 3078F |
|
6,007 |
5,817 |
$0.00 |
| 90670 |
|
4,712 |
4,711 |
$0.00 |
| 90710 |
|
391 |
391 |
$0.00 |
| 90700 |
|
449 |
449 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
345 |
345 |
$0.00 |
| 90648 |
|
68 |
68 |
$0.00 |
| 81003 |
|
30 |
27 |
$0.00 |
| 90380 |
|
19 |
19 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$0.00 |
| 90687 |
|
12 |
12 |
$0.00 |