| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
16,279 |
14,769 |
$4.20M |
| T1015 |
Clinic visit/encounter, all-inclusive |
18,481 |
15,669 |
$3.42M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,270 |
9,417 |
$16K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
823 |
820 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
1,307 |
1,214 |
$1K |
| 90686 |
|
269 |
268 |
$1K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
15 |
14 |
$887.88 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
485 |
483 |
$844.45 |
| G0008 |
Administration of influenza virus vaccine |
158 |
157 |
$812.70 |
| 80053 |
Comprehensive metabolic panel |
943 |
929 |
$748.91 |
| 0011A |
|
34 |
34 |
$684.42 |
| 81002 |
|
337 |
204 |
$577.73 |
| 0012A |
|
27 |
27 |
$523.38 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
610 |
599 |
$389.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
839 |
838 |
$38.58 |
| 80061 |
Lipid panel |
44 |
43 |
$33.27 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
94 |
93 |
$27.74 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,124 |
1,036 |
$1.47 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,995 |
1,868 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,398 |
3,393 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,116 |
4,645 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
648 |
624 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,565 |
2,563 |
$0.00 |
| 3074F |
|
894 |
805 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
80 |
$0.00 |
| 3079F |
|
282 |
271 |
$0.00 |
| 3075F |
|
97 |
96 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
319 |
319 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
39 |
$0.00 |
| D0330 |
Panoramic radiographic image |
2,438 |
2,432 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,965 |
3,958 |
$0.00 |
| 3078F |
|
575 |
523 |
$0.00 |
| D1110 |
Prophylaxis - adult |
3,711 |
3,707 |
$0.00 |
| 1160F |
|
1,563 |
1,422 |
$0.00 |
| 1159F |
|
1,563 |
1,422 |
$0.00 |
| 90461 |
|
552 |
552 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
336 |
336 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
159 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |
| 90671 |
|
25 |
25 |
$0.00 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$0.00 |
| D4910 |
|
12 |
12 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
16 |
16 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
6,346 |
6,237 |
$-36.37 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,696 |
1,763 |
$-216.64 |