| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29,298 |
23,781 |
$3.40M |
| 90832 |
Psychotherapy, 30 minutes with patient |
7,393 |
3,708 |
$1.14M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,802 |
4,824 |
$639K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,808 |
3,775 |
$638K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,183 |
1,005 |
$130K |
| 90791 |
Psychiatric diagnostic evaluation |
764 |
680 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
2,546 |
1,129 |
$124K |
| D1120 |
Prophylaxis - child |
2,099 |
965 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,557 |
913 |
$95K |
| D1330 |
|
2,004 |
705 |
$88K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
489 |
429 |
$77K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
495 |
453 |
$75K |
| 99385 |
|
582 |
525 |
$75K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
506 |
444 |
$70K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
566 |
493 |
$64K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
443 |
432 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
390 |
242 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
624 |
314 |
$40K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
281 |
237 |
$39K |
| 99386 |
|
308 |
296 |
$37K |
| 90834 |
Psychotherapy, 45 minutes with patient |
208 |
155 |
$33K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
263 |
239 |
$33K |
| D1110 |
Prophylaxis - adult |
536 |
356 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
138 |
$25K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
226 |
219 |
$25K |
| 99215 |
Prolong outpt/office vis |
176 |
163 |
$25K |
| 99383 |
|
159 |
135 |
$24K |
| 99406 |
|
887 |
672 |
$23K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
139 |
113 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
581 |
572 |
$16K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,027 |
1,009 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
896 |
733 |
$13K |
| 99205 |
Prolong outpt/office vis |
74 |
61 |
$12K |
| 82948 |
|
1,145 |
921 |
$12K |
| 90670 |
|
112 |
112 |
$7K |
| 36415 |
Collection of venous blood by venipuncture |
2,690 |
2,655 |
$6K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
52 |
40 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
517 |
461 |
$6K |
| D0274 |
Bitewings - four radiographic images |
272 |
218 |
$6K |
| 90461 |
|
166 |
166 |
$6K |
| D1206 |
Topical application of fluoride varnish |
148 |
123 |
$4K |
| 90674 |
|
209 |
209 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
239 |
237 |
$3K |
| 90686 |
|
340 |
340 |
$3K |
| 90732 |
|
36 |
36 |
$3K |
| 90746 |
|
50 |
50 |
$3K |
| 99382 |
|
16 |
15 |
$3K |
| 99407 |
|
139 |
129 |
$2K |
| D1351 |
Sealant - per tooth |
29 |
12 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
113 |
113 |
$2K |
| 81025 |
|
239 |
237 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
29 |
$1K |
| 90656 |
|
95 |
95 |
$1K |
| 11721 |
|
41 |
41 |
$1K |
| 90715 |
|
43 |
43 |
$1K |
| 81000 |
|
438 |
297 |
$1K |
| 90636 |
|
13 |
12 |
$1K |
| 90651 |
|
12 |
12 |
$537.35 |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
146 |
$331.90 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$176.40 |
| 93000 |
|
16 |
16 |
$152.90 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
13 |
13 |
$4.80 |
| 99499 |
|
33 |
24 |
$0.00 |
| 90633 |
|
57 |
57 |
$0.00 |
| 90647 |
|
27 |
27 |
$0.00 |