| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
360,206 |
315,760 |
$1.94M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,506 |
6,377 |
$590K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
8,506 |
4,308 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
4,013 |
3,291 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
895 |
728 |
$85K |
| D1206 |
Topical application of fluoride varnish |
5,539 |
4,468 |
$72K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,788 |
3,942 |
$63K |
| D1110 |
Prophylaxis - adult |
2,097 |
1,609 |
$61K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,975 |
1,621 |
$61K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,870 |
1,624 |
$55K |
| D0330 |
Panoramic radiographic image |
1,698 |
1,251 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,278 |
1,025 |
$46K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,778 |
837 |
$45K |
| D1120 |
Prophylaxis - child |
1,894 |
1,641 |
$45K |
| D1351 |
Sealant - per tooth |
4,023 |
741 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,084 |
682 |
$36K |
| 76801 |
|
708 |
296 |
$36K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
818 |
243 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,883 |
1,403 |
$34K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
615 |
415 |
$33K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
381 |
254 |
$29K |
| 81025 |
|
8,164 |
3,419 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
303 |
240 |
$22K |
| 99215 |
Prolong outpt/office vis |
181 |
88 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
504 |
156 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,040 |
909 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
227 |
203 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
438 |
88 |
$9K |
| 81002 |
|
6,208 |
2,713 |
$8K |
| 36415 |
Collection of venous blood by venipuncture |
5,538 |
2,485 |
$7K |
| 90651 |
|
988 |
408 |
$6K |
| 85018 |
|
3,887 |
1,804 |
$6K |
| 90686 |
|
2,145 |
1,087 |
$5K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,674 |
1,588 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
325 |
255 |
$4K |
| 90734 |
|
927 |
529 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
155 |
89 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
37 |
$3K |
| 99383 |
|
38 |
27 |
$3K |
| 90715 |
|
985 |
469 |
$3K |
| 99384 |
|
12 |
12 |
$2K |
| 90620 |
|
426 |
147 |
$2K |
| 99385 |
|
12 |
12 |
$2K |
| 82947 |
|
386 |
351 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
90 |
13 |
$1K |
| 81003 |
|
1,697 |
574 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
53 |
$1K |
| 90716 |
|
333 |
165 |
$1K |
| 87210 |
|
530 |
215 |
$944.63 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
70 |
31 |
$859.68 |
| 90480 |
|
84 |
37 |
$803.30 |
| 96160 |
|
609 |
222 |
$658.24 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
133 |
31 |
$459.16 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
77 |
41 |
$442.98 |
| 96127 |
|
266 |
90 |
$442.58 |
| 90707 |
|
298 |
135 |
$322.79 |
| 90688 |
|
35 |
34 |
$300.20 |
| 91322 |
|
79 |
33 |
$263.69 |
| 90656 |
|
159 |
123 |
$246.52 |
| 92551 |
|
443 |
130 |
$215.26 |
| 90619 |
|
1,374 |
403 |
$164.86 |
| 99173 |
|
563 |
192 |
$126.80 |
| 96161 |
|
68 |
25 |
$78.54 |
| 81001 |
|
21 |
17 |
$71.39 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,135 |
323 |
$30.56 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,131 |
322 |
$30.56 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
834 |
263 |
$29.92 |
| 90633 |
|
312 |
106 |
$26.06 |
| 86592 |
|
851 |
259 |
$5.31 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
409 |
116 |
$0.00 |
| 36416 |
|
259 |
82 |
$0.00 |
| 90696 |
|
78 |
25 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
152 |
56 |
$0.00 |
| 86850 |
|
145 |
56 |
$0.00 |
| 86803 |
|
290 |
98 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
202 |
70 |
$0.00 |
| 87340 |
|
321 |
123 |
$0.00 |
| G2024 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source |
130 |
68 |
$0.00 |
| 86901 |
|
95 |
43 |
$0.00 |
| 99000 |
|
379 |
244 |
$0.00 |