| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,336 |
14,323 |
$810K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,772 |
7,338 |
$610K |
| D0330 |
Panoramic radiographic image |
1,694 |
1,436 |
$65K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
598 |
586 |
$52K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
522 |
514 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,063 |
1,011 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,294 |
1,131 |
$28K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
355 |
338 |
$27K |
| 92551 |
|
2,183 |
2,134 |
$22K |
| 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 |
1,901 |
1,649 |
$22K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,746 |
5,551 |
$14K |
| 90674 |
|
572 |
557 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
767 |
655 |
$13K |
| D0274 |
Bitewings - four radiographic images |
632 |
622 |
$11K |
| 85018 |
|
4,433 |
4,316 |
$11K |
| D1110 |
Prophylaxis - adult |
236 |
232 |
$9K |
| 81002 |
|
2,854 |
2,795 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,060 |
863 |
$7K |
| 90686 |
|
610 |
595 |
$7K |
| 82947 |
|
1,647 |
1,561 |
$6K |
| 99173 |
|
2,165 |
2,118 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
1,023 |
450 |
$5K |
| 90649 |
|
169 |
159 |
$5K |
| 90756 |
|
281 |
278 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
2,163 |
2,089 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
65 |
$5K |
| 96127 |
|
949 |
884 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,891 |
1,783 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
648 |
630 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
563 |
347 |
$3K |
| 99215 |
Prolong outpt/office vis |
26 |
26 |
$3K |
| 90734 |
|
148 |
142 |
$2K |
| 90656 |
|
86 |
86 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
14 |
14 |
$1K |
| 90688 |
|
89 |
85 |
$951.28 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
87 |
79 |
$592.50 |
| 90661 |
|
39 |
39 |
$509.69 |
| 90689 |
|
47 |
46 |
$492.50 |
| D1120 |
Prophylaxis - child |
28 |
28 |
$480.00 |
| 90619 |
|
29 |
27 |
$397.00 |
| 90620 |
|
32 |
30 |
$346.00 |
| 99188 |
|
18 |
15 |
$311.85 |
| 81025 |
|
34 |
28 |
$214.02 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$174.60 |
| 90670 |
|
14 |
13 |
$143.00 |
| 90633 |
|
17 |
13 |
$132.00 |
| 36416 |
|
27 |
25 |
$26.75 |
| 99000 |
|
207 |
202 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
27 |
27 |
$0.00 |