| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,135 |
18,732 |
$8.76M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
7,169 |
5,973 |
$3.01M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,953 |
4,438 |
$1.99M |
| D0140 |
Limited oral evaluation - problem focused |
3,627 |
3,057 |
$1.22M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,290 |
1,953 |
$849K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
2,202 |
824 |
$718K |
| D1120 |
Prophylaxis - child |
4,250 |
3,273 |
$620K |
| D1206 |
Topical application of fluoride varnish |
7,501 |
6,209 |
$606K |
| D0220 |
Intraoral - periapical first radiographic image |
4,677 |
3,784 |
$551K |
| D0120 |
Periodic oral evaluation - established patient |
2,637 |
2,095 |
$509K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,152 |
1,076 |
$452K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,164 |
1,053 |
$341K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
715 |
688 |
$297K |
| D0274 |
Bitewings - four radiographic images |
2,168 |
1,779 |
$254K |
| 90670 |
|
1,157 |
985 |
$251K |
| D1110 |
Prophylaxis - adult |
1,693 |
1,333 |
$241K |
| 99442 |
|
596 |
561 |
$239K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
503 |
453 |
$228K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,028 |
1,510 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,146 |
934 |
$184K |
| D1351 |
Sealant - per tooth |
5,881 |
1,530 |
$180K |
| 92015 |
Determination of refractive state |
2,894 |
2,729 |
$167K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
832 |
712 |
$154K |
| 99441 |
|
313 |
301 |
$153K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
376 |
343 |
$135K |
| D0330 |
Panoramic radiographic image |
1,126 |
968 |
$115K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
259 |
251 |
$109K |
| D1330 |
|
499 |
444 |
$105K |
| 90710 |
|
344 |
296 |
$101K |
| 99173 |
|
225 |
207 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
893 |
353 |
$91K |
| 99443 |
|
181 |
175 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
369 |
301 |
$87K |
| D0272 |
Bitewings - two radiographic images |
1,119 |
915 |
$85K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
717 |
615 |
$83K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
244 |
216 |
$71K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,543 |
2,156 |
$60K |
| 0011A |
|
146 |
139 |
$59K |
| 0012A |
|
134 |
134 |
$58K |
| 0001A |
|
150 |
146 |
$58K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
170 |
151 |
$56K |
| 0002A |
|
116 |
116 |
$56K |
| 94760 |
|
570 |
457 |
$51K |
| 99188 |
|
1,064 |
948 |
$48K |
| 99406 |
|
209 |
147 |
$43K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
691 |
262 |
$42K |
| 99606 |
|
120 |
92 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
134 |
$34K |
| 96127 |
|
120 |
112 |
$33K |
| 90651 |
|
194 |
157 |
$31K |
| 0071A |
|
62 |
52 |
$30K |
| 0064A |
|
104 |
84 |
$29K |
| 92551 |
|
65 |
65 |
$29K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
681 |
610 |
$28K |
| 90734 |
|
177 |
155 |
$20K |
| 0072A |
|
32 |
32 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,289 |
871 |
$16K |
| 90686 |
|
462 |
435 |
$14K |
| 97161 |
|
25 |
25 |
$12K |
| 90633 |
|
359 |
325 |
$10K |
| 90461 |
|
1,917 |
1,387 |
$10K |
| D2940 |
|
387 |
134 |
$10K |
| 92002 |
|
15 |
15 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
14 |
$7K |
| 90750 |
|
26 |
24 |
$7K |
| D2140 |
|
44 |
26 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
16 |
$6K |
| D0270 |
|
90 |
76 |
$5K |
| D1354 |
|
74 |
12 |
$5K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
14 |
14 |
$5K |
| D2331 |
|
26 |
12 |
$3K |
| 90723 |
|
739 |
629 |
$3K |
| 92552 |
|
26 |
26 |
$3K |
| 96160 |
|
16 |
12 |
$2K |
| 90715 |
|
14 |
14 |
$854.00 |
| 92285 |
|
13 |
13 |
$854.00 |
| 99177 |
|
60 |
57 |
$427.00 |
| 96161 |
|
29 |
25 |
$427.00 |
| Q3014 |
Telehealth originating site facility fee |
39 |
36 |
$211.99 |
| 36415 |
Collection of venous blood by venipuncture |
7,875 |
6,768 |
$50.23 |
| 80053 |
Comprehensive metabolic panel |
2,723 |
2,428 |
$21.43 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,247 |
2,962 |
$10.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
2,983 |
2,596 |
$7.77 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,148 |
1,061 |
$0.00 |
| 86703 |
|
918 |
793 |
$0.00 |
| 84439 |
|
609 |
551 |
$0.00 |
| 80061 |
Lipid panel |
1,322 |
1,221 |
$0.00 |
| 81025 |
|
729 |
640 |
$0.00 |
| 80305 |
|
369 |
314 |
$0.00 |
| 83718 |
|
32 |
30 |
$0.00 |
| D4341 |
|
26 |
14 |
$0.00 |
| 81003 |
|
642 |
517 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
666 |
591 |
$0.00 |
| 82570 |
|
185 |
171 |
$0.00 |
| 82465 |
|
33 |
31 |
$0.00 |
| D0190 |
|
115 |
102 |
$0.00 |
| 83655 |
|
12 |
12 |
$0.00 |
| 71046 |
Radiologic examination, chest; 2 views |
46 |
43 |
$0.00 |
| D9330 |
|
19 |
19 |
$0.00 |
| 90700 |
|
28 |
27 |
$0.00 |
| D0460 |
|
14 |
12 |
$0.00 |
| 87210 |
|
31 |
24 |
$0.00 |
| D0191 |
|
63 |
63 |
$0.00 |
| 90473 |
|
14 |
14 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14 |
12 |
$0.00 |
| 90672 |
|
17 |
17 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
3,253 |
2,733 |
$0.00 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
170 |
162 |
$0.00 |
| 86803 |
|
133 |
115 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,329 |
1,172 |
$0.00 |
| 90647 |
|
741 |
645 |
$0.00 |
| 90680 |
|
300 |
284 |
$0.00 |
| DIH01 |
|
24 |
24 |
$0.00 |
| 92583 |
|
13 |
13 |
$0.00 |
| 81000 |
|
47 |
41 |
$0.00 |
| 82043 |
|
160 |
147 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
220 |
201 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
69 |
63 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
105 |
103 |
$0.00 |
| 82044 |
|
74 |
68 |
$0.00 |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
183 |
168 |
$0.00 |
| 92250 |
|
12 |
12 |
$0.00 |
| 93000 |
|
13 |
12 |
$0.00 |
| 90696 |
|
45 |
44 |
$0.00 |
| D1310 |
|
22 |
22 |
$0.00 |
| 85651 |
|
12 |
12 |
$0.00 |
| D0000 |
|
17 |
17 |
$0.00 |
| 82962 |
|
19 |
13 |
$0.00 |
| 36416 |
|
16 |
14 |
$0.00 |