| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,475 |
9,217 |
$322K |
| H1000 |
Prenatal care, at-risk assessment |
5,691 |
3,421 |
$191K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,859 |
2,474 |
$96K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,211 |
996 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,617 |
978 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,307 |
1,245 |
$41K |
| D1110 |
Prophylaxis - adult |
1,389 |
1,369 |
$31K |
| 98940 |
|
2,061 |
649 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
544 |
460 |
$29K |
| D0330 |
Panoramic radiographic image |
1,670 |
1,557 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,052 |
732 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,289 |
2,068 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
206 |
$20K |
| D1330 |
|
2,319 |
2,183 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,760 |
1,455 |
$16K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,772 |
1,409 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
235 |
215 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,964 |
1,572 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
1,256 |
1,185 |
$14K |
| 99401 |
|
1,056 |
952 |
$13K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
201 |
194 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
921 |
553 |
$12K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
192 |
161 |
$10K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
323 |
283 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
170 |
145 |
$8K |
| D0274 |
Bitewings - four radiographic images |
971 |
937 |
$7K |
| 99385 |
|
125 |
97 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,441 |
1,344 |
$6K |
| 59430 |
|
141 |
114 |
$5K |
| 99381 |
|
72 |
57 |
$5K |
| 81025 |
|
1,473 |
1,201 |
$3K |
| 90461 |
|
1,251 |
589 |
$3K |
| D4346 |
|
109 |
109 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,791 |
2,563 |
$3K |
| D1120 |
Prophylaxis - child |
138 |
134 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
46 |
$2K |
| 90670 |
|
479 |
418 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,046 |
872 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
489 |
405 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
41 |
31 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
24 |
15 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
85 |
31 |
$1K |
| D0191 |
|
793 |
738 |
$1K |
| 99386 |
|
16 |
12 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$897.25 |
| 3074F |
|
14,041 |
9,906 |
$867.20 |
| 36415 |
Collection of venous blood by venipuncture |
1,769 |
1,432 |
$850.17 |
| 87428 |
|
18 |
14 |
$676.44 |
| D0603 |
|
1,671 |
1,528 |
$560.11 |
| 81002 |
|
1,670 |
1,021 |
$544.77 |
| 92558 |
|
108 |
107 |
$494.94 |
| 81003 |
|
1,598 |
985 |
$474.47 |
| 0012A |
|
19 |
18 |
$452.95 |
| D1351 |
Sealant - per tooth |
53 |
12 |
$424.56 |
| 90686 |
|
245 |
231 |
$404.80 |
| D9995 |
|
52 |
47 |
$303.15 |
| 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 |
429 |
271 |
$293.27 |
| 90647 |
|
97 |
93 |
$256.60 |
| 82962 |
|
191 |
183 |
$248.82 |
| 0011A |
|
22 |
17 |
$223.61 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$211.18 |
| 90697 |
|
154 |
125 |
$183.82 |
| 90698 |
|
15 |
12 |
$179.02 |
| D0190 |
|
16 |
16 |
$140.11 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
36 |
12 |
$121.91 |
| D0272 |
Bitewings - two radiographic images |
41 |
40 |
$116.76 |
| 90710 |
|
15 |
15 |
$101.40 |
| 90681 |
|
49 |
41 |
$99.51 |
| D0601 |
|
639 |
590 |
$98.00 |
| D0602 |
|
483 |
445 |
$90.29 |
| 3079F |
|
3,517 |
2,517 |
$89.05 |
| 3075F |
|
670 |
489 |
$75.00 |
| 2001F |
|
22,789 |
16,076 |
$73.80 |
| 90633 |
|
207 |
167 |
$71.92 |
| 85018 |
|
177 |
157 |
$57.93 |
| 83655 |
|
31 |
29 |
$56.87 |
| D0270 |
|
197 |
177 |
$55.05 |
| 90651 |
|
48 |
37 |
$40.00 |
| 90723 |
|
15 |
13 |
$40.00 |
| 99173 |
|
953 |
780 |
$40.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$31.76 |
| 1159F |
|
17,587 |
13,426 |
$27.54 |
| 2010F |
|
6,353 |
5,062 |
$21.94 |
| 2000F |
|
18,901 |
12,851 |
$19.20 |
| 3078F |
|
11,683 |
7,974 |
$17.60 |
| 3008F |
|
17,357 |
12,318 |
$15.85 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
13 |
$13.91 |
| 90674 |
|
39 |
29 |
$12.10 |
| 1036F |
|
1,322 |
990 |
$9.33 |
| 96127 |
|
851 |
661 |
$6.97 |
| 1126F |
|
2,691 |
2,190 |
$0.00 |
| 1220F |
|
6,913 |
5,654 |
$0.00 |
| 1157F |
|
289 |
123 |
$0.00 |
| 4000F |
|
3,859 |
3,054 |
$0.00 |
| 1000F |
|
14,465 |
10,319 |
$0.00 |
| D1310 |
|
529 |
504 |
$0.00 |
| 99000 |
|
121 |
74 |
$0.00 |
| 92551 |
|
498 |
468 |
$0.00 |
| 3044F |
|
2,432 |
1,697 |
$0.00 |
| 36416 |
|
120 |
113 |
$0.00 |
| D4999 |
|
691 |
673 |
$0.00 |
| 1125F |
|
998 |
422 |
$0.00 |
| 1055F |
|
442 |
428 |
$0.00 |
| 3351F |
|
26 |
26 |
$0.00 |
| 0501F |
|
49 |
37 |
$0.00 |
| 4037F |
|
24 |
24 |
$0.00 |
| 90744 |
|
18 |
12 |
$0.00 |
| 96161 |
|
22 |
17 |
$0.00 |
| 1160F |
|
17,663 |
13,480 |
$0.00 |
| 2028F |
|
363 |
339 |
$0.00 |
| 90671 |
|
12 |
12 |
$0.00 |
| 0502F |
|
183 |
147 |
$0.00 |
| 3077F |
|
45 |
39 |
$0.00 |
| 90700 |
|
13 |
12 |
$0.00 |
| 1039F |
|
12 |
12 |
$0.00 |