| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
21,622 |
19,310 |
$1.77M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,178 |
10,233 |
$1.33M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,684 |
269 |
$714K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,688 |
568 |
$258K |
| D1110 |
Prophylaxis - adult |
1,716 |
1,600 |
$157K |
| D0274 |
Bitewings - four radiographic images |
2,182 |
2,059 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
1,839 |
1,730 |
$136K |
| D0330 |
Panoramic radiographic image |
950 |
866 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
3,155 |
2,806 |
$89K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,268 |
875 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
895 |
749 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
616 |
562 |
$51K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
394 |
380 |
$45K |
| 90837 |
Psychotherapy, 53 minutes with patient |
392 |
321 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
109 |
$41K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
187 |
181 |
$41K |
| 90832 |
Psychotherapy, 30 minutes with patient |
744 |
654 |
$36K |
| 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 |
1,106 |
904 |
$33K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
594 |
538 |
$25K |
| 81025 |
|
1,654 |
1,456 |
$25K |
| 86803 |
|
148 |
146 |
$23K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
897 |
852 |
$17K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
266 |
250 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
244 |
234 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
25 |
$11K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
49 |
47 |
$5K |
| D2331 |
|
34 |
13 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
93 |
91 |
$4K |
| 86703 |
|
71 |
70 |
$3K |
| 90791 |
Psychiatric diagnostic evaluation |
26 |
21 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
216 |
206 |
$3K |
| 83037 |
|
313 |
301 |
$3K |
| D4910 |
|
12 |
12 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
51 |
51 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
46 |
46 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
15 |
$2K |
| 80305 |
|
86 |
77 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$678.31 |
| 99382 |
|
18 |
18 |
$442.80 |
| D0270 |
|
17 |
14 |
$416.76 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
23 |
$344.24 |
| 81003 |
|
16 |
15 |
$44.60 |
| D0603 |
|
12 |
12 |
$0.00 |
| D1330 |
|
15 |
15 |
$0.00 |