| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,609 |
7,026 |
$234K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,334 |
1,117 |
$41K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
307 |
270 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
770 |
484 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
368 |
330 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
500 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
241 |
232 |
$15K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
245 |
226 |
$15K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
868 |
797 |
$13K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
258 |
221 |
$13K |
| D1330 |
|
970 |
944 |
$12K |
| 99401 |
|
878 |
782 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
442 |
364 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,108 |
1,045 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
227 |
214 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
839 |
791 |
$7K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
107 |
93 |
$6K |
| D1110 |
Prophylaxis - adult |
248 |
247 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
116 |
106 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
735 |
654 |
$6K |
| D0274 |
Bitewings - four radiographic images |
586 |
579 |
$5K |
| D0330 |
Panoramic radiographic image |
119 |
112 |
$5K |
| 99385 |
|
59 |
54 |
$4K |
| D1206 |
Topical application of fluoride varnish |
969 |
943 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
457 |
413 |
$2K |
| 99384 |
|
31 |
29 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
219 |
160 |
$2K |
| 91301 |
|
59 |
57 |
$2K |
| 81025 |
|
1,426 |
1,227 |
$2K |
| 90461 |
|
683 |
251 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
2,175 |
1,890 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
141 |
134 |
$1K |
| 99383 |
|
21 |
17 |
$1K |
| D0191 |
|
600 |
581 |
$832.50 |
| D0220 |
Intraoral - periapical first radiographic image |
1,158 |
1,084 |
$811.42 |
| 90661 |
|
40 |
40 |
$755.40 |
| 3074F |
|
6,851 |
6,024 |
$525.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$442.01 |
| D1351 |
Sealant - per tooth |
45 |
12 |
$380.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
41 |
41 |
$276.00 |
| D4341 |
|
27 |
13 |
$261.60 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
244 |
173 |
$250.77 |
| 90674 |
|
74 |
66 |
$246.67 |
| D0270 |
|
117 |
115 |
$243.98 |
| D4342 |
|
25 |
15 |
$171.60 |
| 3075F |
|
526 |
453 |
$150.00 |
| D9430 |
|
42 |
39 |
$130.32 |
| 82962 |
|
356 |
300 |
$118.39 |
| 90651 |
|
96 |
89 |
$115.88 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
27 |
27 |
$93.40 |
| 3078F |
|
5,560 |
4,753 |
$85.66 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
167 |
116 |
$80.09 |
| D0603 |
|
394 |
376 |
$56.00 |
| 85018 |
|
74 |
64 |
$53.21 |
| 81002 |
|
75 |
61 |
$43.68 |
| 92558 |
|
15 |
15 |
$39.25 |
| D0601 |
|
161 |
154 |
$26.00 |
| 96127 |
|
1,123 |
1,002 |
$10.20 |
| 2001F |
|
12,739 |
10,799 |
$8.08 |
| 81003 |
|
745 |
708 |
$4.44 |
| D0602 |
|
101 |
101 |
$2.00 |
| 1160F |
|
8,813 |
7,616 |
$1.54 |
| 3079F |
|
2,129 |
1,802 |
$0.00 |
| 4000F |
|
3,411 |
3,052 |
$0.00 |
| 1000F |
|
7,099 |
6,240 |
$0.00 |
| 1220F |
|
5,642 |
5,045 |
$0.00 |
| 2000F |
|
10,207 |
8,590 |
$0.00 |
| D4999 |
|
173 |
168 |
$0.00 |
| 3008F |
|
11,474 |
9,546 |
$0.00 |
| D1310 |
|
622 |
600 |
$0.00 |
| 1126F |
|
1,602 |
1,442 |
$0.00 |
| 2010F |
|
3,355 |
3,101 |
$0.00 |
| 1055F |
|
391 |
380 |
$0.00 |
| 1125F |
|
110 |
98 |
$0.00 |
| 92551 |
|
122 |
120 |
$0.00 |
| 4010F |
|
70 |
58 |
$0.00 |
| 3080F |
|
90 |
69 |
$0.00 |
| 1036F |
|
1,095 |
1,024 |
$0.00 |
| 3044F |
|
685 |
624 |
$0.00 |
| 36416 |
|
266 |
195 |
$0.00 |
| 90686 |
|
62 |
56 |
$0.00 |
| 3352F |
|
26 |
25 |
$0.00 |
| 3351F |
|
360 |
355 |
$0.00 |
| 1157F |
|
139 |
70 |
$0.00 |
| 99000 |
|
87 |
65 |
$0.00 |
| 1034F |
|
35 |
34 |
$0.00 |
| 90619 |
|
12 |
12 |
$0.00 |
| 3353F |
|
27 |
26 |
$0.00 |
| 1159F |
|
8,756 |
7,567 |
$0.00 |
| 99173 |
|
827 |
780 |
$0.00 |
| 3210F |
|
58 |
52 |
$0.00 |
| 3725F |
|
14 |
12 |
$0.00 |
| 90633 |
|
107 |
86 |
$0.00 |
| 3077F |
|
282 |
198 |
$0.00 |
| 99177 |
|
68 |
65 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |
| 4035F |
|
33 |
33 |
$0.00 |
| 90715 |
|
16 |
16 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |