| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
149,964 |
139,191 |
$772K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,750 |
882 |
$195K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,763 |
1,251 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,638 |
776 |
$135K |
| D1351 |
Sealant - per tooth |
4,622 |
1,028 |
$133K |
| D1120 |
Prophylaxis - child |
4,193 |
4,024 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
3,611 |
3,436 |
$93K |
| D1206 |
Topical application of fluoride varnish |
4,924 |
4,695 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,673 |
1,609 |
$78K |
| D0330 |
Panoramic radiographic image |
1,195 |
1,136 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
2,828 |
2,746 |
$46K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
867 |
620 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,406 |
2,490 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,272 |
2,182 |
$42K |
| D1110 |
Prophylaxis - adult |
735 |
696 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
458 |
382 |
$20K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
658 |
541 |
$16K |
| D0274 |
Bitewings - four radiographic images |
435 |
416 |
$16K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
755 |
558 |
$8K |
| 97803 |
|
498 |
294 |
$7K |
| D9110 |
|
159 |
155 |
$7K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
355 |
268 |
$5K |
| 81003 |
|
2,115 |
1,226 |
$3K |
| 81025 |
|
445 |
298 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
2,077 |
1,544 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
53 |
$2K |
| D4355 |
|
46 |
38 |
$2K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
34 |
28 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
63 |
47 |
$1K |
| 0071A |
|
16 |
12 |
$798.86 |
| 87210 |
|
207 |
169 |
$793.59 |
| 82120 |
|
191 |
157 |
$777.21 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
354 |
267 |
$566.09 |
| D1354 |
|
100 |
25 |
$428.38 |
| 90715 |
|
37 |
28 |
$362.14 |
| 85018 |
|
150 |
121 |
$357.10 |
| D1355 |
|
269 |
42 |
$313.50 |
| 97802 |
|
17 |
14 |
$269.61 |
| 90734 |
|
75 |
60 |
$268.03 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
43 |
25 |
$266.91 |
| 90688 |
|
46 |
32 |
$179.96 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
18 |
13 |
$138.00 |
| 82950 |
|
14 |
13 |
$84.56 |
| 96127 |
|
27 |
15 |
$62.86 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
491 |
404 |
$62.71 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
497 |
408 |
$62.36 |
| 99000 |
|
1,767 |
1,272 |
$36.02 |
| 86701 |
|
162 |
118 |
$16.60 |
| 86593 |
|
163 |
117 |
$13.96 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
81 |
54 |
$0.00 |
| 83020 |
|
23 |
16 |
$0.00 |
| 91300 |
|
57 |
38 |
$0.00 |
| 86787 |
|
20 |
15 |
$0.00 |
| 86900 |
|
20 |
15 |
$0.00 |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
36 |
27 |
$0.00 |
| 90756 |
|
13 |
12 |
$0.00 |
| 90686 |
|
91 |
71 |
$0.00 |
| 87340 |
|
20 |
15 |
$0.00 |
| 86901 |
|
20 |
15 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
35 |
27 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
23 |
16 |
$0.00 |
| 91307 |
|
16 |
12 |
$0.00 |
| 86850 |
|
20 |
15 |
$0.00 |