| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
13,517 |
7,587 |
$1.11M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
40,233 |
27,829 |
$1.02M |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,006 |
3,796 |
$297K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,852 |
2,823 |
$224K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,477 |
2,844 |
$215K |
| D1110 |
Prophylaxis - adult |
4,689 |
4,654 |
$173K |
| D1120 |
Prophylaxis - child |
3,593 |
3,569 |
$126K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,480 |
1,678 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,374 |
1,815 |
$116K |
| D0330 |
Panoramic radiographic image |
1,283 |
1,277 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,595 |
1,169 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
3,270 |
3,190 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,376 |
1,363 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
813 |
751 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
761 |
723 |
$28K |
| D1206 |
Topical application of fluoride varnish |
8,922 |
8,853 |
$25K |
| 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 |
2,053 |
1,496 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
434 |
434 |
$21K |
| 99381 |
|
243 |
164 |
$20K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
760 |
383 |
$17K |
| D1351 |
Sealant - per tooth |
1,933 |
270 |
$15K |
| D0274 |
Bitewings - four radiographic images |
2,534 |
2,516 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
105 |
$12K |
| 90832 |
Psychotherapy, 30 minutes with patient |
342 |
253 |
$12K |
| D0191 |
|
4,211 |
4,167 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15,523 |
11,392 |
$12K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
7,455 |
5,497 |
$10K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
762 |
497 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
3,076 |
3,043 |
$7K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,215 |
921 |
$6K |
| 90686 |
|
5,997 |
5,121 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
100 |
86 |
$4K |
| D9996 |
|
944 |
926 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
31 |
27 |
$3K |
| 99188 |
|
1,617 |
1,261 |
$3K |
| D0350 |
|
937 |
922 |
$2K |
| D1330 |
|
9,486 |
9,383 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,850 |
3,217 |
$2K |
| 0002A |
|
54 |
54 |
$1K |
| 99215 |
Prolong outpt/office vis |
13 |
13 |
$1K |
| 90670 |
|
2,751 |
1,933 |
$1K |
| D0272 |
Bitewings - two radiographic images |
1,328 |
1,317 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,104 |
2,077 |
$775.90 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$716.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,164 |
1,083 |
$680.62 |
| 0001A |
|
48 |
48 |
$625.01 |
| V2020 |
Frames, purchases |
238 |
224 |
$623.30 |
| 90651 |
|
1,097 |
796 |
$606.39 |
| 90633 |
|
854 |
760 |
$455.93 |
| 81329 |
|
291 |
217 |
$303.93 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
25 |
$300.72 |
| 81003 |
|
12,239 |
6,914 |
$291.21 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
130 |
98 |
$287.15 |
| 3074F |
|
213 |
181 |
$225.00 |
| 90620 |
|
171 |
155 |
$205.00 |
| 85018 |
|
1,960 |
1,476 |
$180.54 |
| 90674 |
|
94 |
87 |
$151.18 |
| 90685 |
|
187 |
178 |
$120.00 |
| 0011A |
|
12 |
12 |
$118.58 |
| 90707 |
|
39 |
39 |
$97.84 |
| 0012A |
|
15 |
14 |
$85.17 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
200 |
186 |
$75.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
17 |
17 |
$40.00 |
| 90700 |
|
37 |
36 |
$38.00 |
| 92015 |
Determination of refractive state |
1,550 |
1,447 |
$37.57 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
349 |
310 |
$35.00 |
| 90716 |
|
52 |
52 |
$28.00 |
| 90734 |
|
829 |
497 |
$25.00 |
| 90696 |
|
12 |
12 |
$20.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,321 |
762 |
$15.88 |
| 90723 |
|
1,702 |
1,130 |
$5.00 |
| 90647 |
|
1,425 |
1,090 |
$5.00 |
| 1159F |
|
834 |
754 |
$0.00 |
| 1160F |
|
833 |
754 |
$0.00 |
| 3078F |
|
186 |
159 |
$0.00 |
| 90715 |
|
294 |
209 |
$0.00 |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
26 |
26 |
$0.00 |
| D0180 |
|
84 |
84 |
$0.00 |
| 91300 |
|
139 |
116 |
$0.00 |
| 90710 |
|
30 |
27 |
$0.00 |
| 90681 |
|
306 |
171 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
83 |
82 |
$0.00 |
| 86787 |
|
27 |
27 |
$0.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
12 |
12 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
40 |
38 |
$0.00 |
| 86703 |
|
20 |
17 |
$0.00 |
| 81025 |
|
17 |
14 |
$0.00 |
| 1126F |
|
551 |
527 |
$0.00 |
| 2020F |
|
879 |
823 |
$0.00 |
| D1310 |
|
4,419 |
4,373 |
$0.00 |
| 1036F |
|
28 |
28 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
910 |
865 |
$0.00 |
| D0603 |
|
48 |
48 |
$0.00 |
| 91301 |
|
15 |
14 |
$0.00 |
| 88174 |
|
53 |
51 |
$0.00 |
| 87428 |
|
506 |
199 |
$0.00 |
| 1000F |
|
28 |
28 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
40 |
38 |
$0.00 |
| 92551 |
|
14 |
14 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
27 |
27 |
$0.00 |
| 85660 |
|
12 |
12 |
$0.00 |
| 90688 |
|
78 |
70 |
$0.00 |
| D0601 |
|
38 |
37 |
$0.00 |
| 83789 |
|
26 |
26 |
$0.00 |
| G0123 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
12 |
12 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
12 |
12 |
$0.00 |
| 80055 |
|
26 |
26 |
$0.00 |
| 92250 |
|
14 |
14 |
$0.00 |