| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
480,891 |
477,540 |
$2.41M |
| D0120 |
Periodic oral evaluation - established patient |
7,561 |
7,517 |
$231K |
| D1110 |
Prophylaxis - adult |
4,290 |
4,257 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,564 |
1,120 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,922 |
1,393 |
$167K |
| D1206 |
Topical application of fluoride varnish |
7,562 |
7,502 |
$142K |
| D1120 |
Prophylaxis - child |
3,816 |
3,801 |
$124K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,462 |
6,407 |
$110K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,665 |
3,088 |
$98K |
| D0330 |
Panoramic radiographic image |
1,391 |
1,384 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,073 |
2,051 |
$78K |
| T1002 |
Rn services, up to 15 minutes |
1,841 |
1,400 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,111 |
1,093 |
$55K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
887 |
598 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,768 |
1,765 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
967 |
946 |
$37K |
| D1351 |
Sealant - per tooth |
785 |
351 |
$25K |
| 0001A |
|
361 |
306 |
$20K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,307 |
1,184 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,174 |
1,136 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
233 |
231 |
$17K |
| 90651 |
|
652 |
551 |
$17K |
| 0002A |
|
332 |
267 |
$17K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
475 |
416 |
$17K |
| 99383 |
|
168 |
134 |
$16K |
| 90734 |
|
857 |
711 |
$15K |
| 90715 |
|
1,160 |
951 |
$14K |
| 81025 |
|
1,613 |
1,357 |
$13K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
190 |
180 |
$11K |
| 90686 |
|
2,315 |
2,090 |
$10K |
| 87210 |
|
1,908 |
1,582 |
$9K |
| 36415 |
Collection of venous blood by venipuncture |
3,241 |
2,728 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
155 |
138 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
51 |
$7K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
94 |
80 |
$6K |
| 0071A |
|
110 |
77 |
$6K |
| 0072A |
|
80 |
57 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
416 |
345 |
$4K |
| 90619 |
|
875 |
694 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
38 |
26 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
26 |
26 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
16 |
$3K |
| 83986 |
|
815 |
699 |
$3K |
| 90620 |
|
103 |
75 |
$2K |
| 85018 |
|
660 |
602 |
$2K |
| 99385 |
|
12 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
117 |
$2K |
| 90480 |
|
30 |
26 |
$2K |
| D0240 |
|
100 |
53 |
$2K |
| 0004A |
|
27 |
17 |
$2K |
| 90716 |
|
176 |
176 |
$1K |
| 80305 |
|
98 |
92 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$1K |
| 81003 |
|
836 |
505 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$1K |
| 91320 |
|
21 |
18 |
$975.09 |
| 90656 |
|
101 |
98 |
$699.84 |
| 90633 |
|
359 |
303 |
$648.78 |
| 90682 |
|
13 |
13 |
$610.48 |
| 90670 |
|
296 |
272 |
$363.68 |
| 90707 |
|
146 |
145 |
$297.14 |
| 96160 |
|
77 |
77 |
$287.98 |
| 90710 |
|
181 |
139 |
$267.15 |
| 85013 |
|
107 |
100 |
$261.87 |
| 96127 |
|
40 |
27 |
$210.17 |
| 0031A |
|
23 |
20 |
$113.56 |
| 90696 |
|
126 |
100 |
$51.63 |
| 99173 |
|
425 |
415 |
$24.00 |
| 92551 |
|
224 |
224 |
$16.00 |
| 99000 |
|
2,076 |
1,880 |
$0.00 |
| 91307 |
|
243 |
141 |
$0.00 |
| 90698 |
|
95 |
85 |
$0.00 |
| 36416 |
|
237 |
211 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,167 |
1,063 |
$0.00 |
| 86592 |
|
1,221 |
1,133 |
$0.00 |
| 86850 |
|
64 |
53 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
70 |
59 |
$0.00 |
| 90677 |
|
40 |
40 |
$0.00 |
| 90744 |
|
76 |
65 |
$0.00 |
| 86901 |
|
62 |
52 |
$0.00 |
| 91303 |
|
23 |
20 |
$0.00 |
| 87340 |
|
62 |
52 |
$0.00 |
| 91305 |
|
55 |
34 |
$0.00 |
| 86803 |
|
14 |
14 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,167 |
1,063 |
$0.00 |
| 86703 |
|
1,216 |
1,130 |
$0.00 |
| 83020 |
|
53 |
53 |
$0.00 |
| 91300 |
|
792 |
588 |
$0.00 |
| 83655 |
|
38 |
38 |
$0.00 |
| 86900 |
|
62 |
52 |
$0.00 |
| 90713 |
|
13 |
13 |
$0.00 |
| 90685 |
|
70 |
70 |
$0.00 |