| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
191,176 |
175,497 |
$1.00M |
| D0120 |
Periodic oral evaluation - established patient |
16,839 |
16,514 |
$480K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,293 |
3,409 |
$453K |
| D1120 |
Prophylaxis - child |
12,585 |
12,375 |
$349K |
| D1206 |
Topical application of fluoride varnish |
21,224 |
20,372 |
$342K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,574 |
1,858 |
$296K |
| D1351 |
Sealant - per tooth |
19,172 |
5,297 |
$259K |
| D1110 |
Prophylaxis - adult |
4,994 |
4,894 |
$199K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,795 |
3,655 |
$190K |
| D0140 |
Limited oral evaluation - problem focused |
3,682 |
3,636 |
$158K |
| D0272 |
Bitewings - two radiographic images |
6,587 |
6,443 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,392 |
619 |
$100K |
| D0330 |
Panoramic radiographic image |
1,826 |
1,785 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
3,679 |
3,548 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
791 |
763 |
$37K |
| 0001A |
|
627 |
509 |
$30K |
| D0240 |
|
1,530 |
922 |
$29K |
| 0002A |
|
594 |
460 |
$28K |
| D0274 |
Bitewings - four radiographic images |
740 |
717 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
111 |
25 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,025 |
558 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
229 |
173 |
$14K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
465 |
387 |
$12K |
| D2330 |
|
154 |
67 |
$10K |
| D9110 |
|
206 |
200 |
$9K |
| D9420 |
|
67 |
64 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
61 |
49 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
471 |
347 |
$5K |
| 0072A |
|
71 |
50 |
$3K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
390 |
313 |
$3K |
| 0004A |
|
58 |
45 |
$3K |
| 0012A |
|
89 |
88 |
$3K |
| 0071A |
|
44 |
35 |
$2K |
| 0011A |
|
93 |
90 |
$2K |
| 0013A |
|
26 |
26 |
$2K |
| 87210 |
|
280 |
240 |
$917.56 |
| 36415 |
Collection of venous blood by venipuncture |
439 |
359 |
$905.91 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
52 |
49 |
$598.50 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
20 |
15 |
$261.05 |
| D1354 |
|
41 |
27 |
$252.26 |
| D0270 |
|
26 |
26 |
$137.17 |
| 90686 |
|
99 |
80 |
$133.70 |
| 91307 |
|
131 |
95 |
$25.00 |
| 91300 |
|
1,434 |
1,083 |
$12.86 |
| 90734 |
|
28 |
17 |
$0.59 |
| D0190 |
|
161 |
159 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
72 |
61 |
$0.00 |
| 86703 |
|
27 |
26 |
$0.00 |
| 90715 |
|
20 |
12 |
$0.00 |
| 99000 |
|
1,434 |
1,144 |
$0.00 |
| 91301 |
|
206 |
200 |
$0.00 |
| 86593 |
|
27 |
26 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
72 |
61 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
18 |
18 |
$0.00 |
| 90619 |
|
47 |
32 |
$0.00 |
| D1353 |
|
35 |
18 |
$0.00 |
| 90674 |
|
31 |
28 |
$0.00 |