| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20,617 |
14,088 |
$1.40M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,242 |
6,066 |
$562K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,201 |
2,392 |
$209K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,501 |
1,216 |
$202K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,706 |
2,017 |
$156K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,955 |
1,591 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
943 |
843 |
$61K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
558 |
390 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
493 |
432 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
552 |
321 |
$28K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,388 |
4,547 |
$18K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
260 |
205 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
362 |
356 |
$15K |
| 99050 |
|
1,583 |
1,123 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
183 |
104 |
$11K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
12,719 |
8,695 |
$10K |
| D0330 |
Panoramic radiographic image |
568 |
516 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
169 |
112 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
143 |
139 |
$6K |
| D1120 |
Prophylaxis - child |
1,419 |
1,299 |
$5K |
| 99381 |
|
57 |
50 |
$5K |
| 99051 |
|
488 |
340 |
$4K |
| D1206 |
Topical application of fluoride varnish |
1,349 |
1,239 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
121 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
53 |
28 |
$3K |
| 96161 |
|
2,567 |
1,783 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,553 |
1,336 |
$2K |
| D0272 |
Bitewings - two radiographic images |
323 |
285 |
$2K |
| 90686 |
|
1,158 |
898 |
$2K |
| D0274 |
Bitewings - four radiographic images |
245 |
227 |
$2K |
| 90670 |
|
2,549 |
1,863 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$1K |
| 90461 |
|
4,655 |
3,320 |
$1K |
| 92551 |
|
785 |
482 |
$1K |
| D1351 |
Sealant - per tooth |
78 |
13 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
8,419 |
4,688 |
$878.89 |
| 96127 |
|
1,664 |
788 |
$501.77 |
| 90633 |
|
1,159 |
827 |
$360.91 |
| 85018 |
|
527 |
341 |
$138.97 |
| 99173 |
|
1,057 |
638 |
$134.37 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
8,109 |
2,166 |
$26.82 |
| 90680 |
|
2,107 |
1,477 |
$0.61 |
| 90677 |
|
182 |
180 |
$0.53 |
| 90671 |
|
360 |
180 |
$0.43 |
| 90710 |
|
99 |
69 |
$0.04 |
| 90698 |
|
1,347 |
1,154 |
$0.03 |
| 90696 |
|
40 |
31 |
$0.03 |
| 90697 |
|
983 |
528 |
$0.00 |
| 90744 |
|
437 |
388 |
$0.00 |
| 90716 |
|
147 |
104 |
$0.00 |
| 3008F |
|
1,438 |
800 |
$0.00 |
| 96380 |
|
35 |
24 |
$0.00 |
| 87807 |
|
61 |
44 |
$0.00 |
| 90381 |
|
25 |
12 |
$0.00 |
| 90651 |
|
126 |
58 |
$0.00 |
| 0001A |
|
34 |
30 |
$0.00 |
| 90723 |
|
30 |
24 |
$0.00 |
| 81002 |
|
547 |
291 |
$0.00 |
| 90707 |
|
147 |
104 |
$0.00 |
| 91300 |
|
61 |
56 |
$0.00 |
| 90700 |
|
28 |
24 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
96 |
70 |
$0.00 |
| 96160 |
|
706 |
350 |
$0.00 |
| 90715 |
|
62 |
34 |
$0.00 |
| 90648 |
|
46 |
36 |
$0.00 |
| 90672 |
|
148 |
83 |
$0.00 |
| 90734 |
|
70 |
34 |
$0.00 |
| 90380 |
|
25 |
15 |
$0.00 |