| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
558,248 |
496,119 |
$2.93M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,215 |
3,692 |
$476K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,759 |
2,756 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,217 |
1,907 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
897 |
450 |
$84K |
| D1120 |
Prophylaxis - child |
2,885 |
2,549 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,511 |
2,237 |
$68K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,468 |
4,147 |
$63K |
| D1110 |
Prophylaxis - adult |
1,580 |
1,416 |
$59K |
| T1002 |
Rn services, up to 15 minutes |
1,602 |
940 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,020 |
3,445 |
$59K |
| D1206 |
Topical application of fluoride varnish |
3,642 |
3,224 |
$59K |
| D0330 |
Panoramic radiographic image |
1,104 |
969 |
$58K |
| 99502 |
|
1,297 |
885 |
$55K |
| 99501 |
|
1,332 |
764 |
$45K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,999 |
1,559 |
$43K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,624 |
1,339 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,232 |
2,631 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,280 |
1,098 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,072 |
940 |
$37K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
247 |
187 |
$28K |
| D1351 |
Sealant - per tooth |
1,415 |
246 |
$23K |
| 0001A |
|
346 |
278 |
$17K |
| 96127 |
|
3,832 |
2,716 |
$17K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,647 |
1,324 |
$17K |
| 0002A |
|
359 |
271 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
173 |
148 |
$16K |
| D4355 |
|
258 |
215 |
$15K |
| D0272 |
Bitewings - two radiographic images |
839 |
739 |
$13K |
| 36415 |
Collection of venous blood by venipuncture |
4,601 |
3,306 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
83 |
$11K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
210 |
171 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
152 |
66 |
$9K |
| 87210 |
|
1,832 |
1,030 |
$8K |
| 90688 |
|
1,288 |
772 |
$8K |
| 0071A |
|
150 |
96 |
$6K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,306 |
1,034 |
$5K |
| 80305 |
|
509 |
256 |
$5K |
| 0072A |
|
113 |
80 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
58 |
51 |
$4K |
| 0064A |
|
88 |
73 |
$4K |
| 99406 |
|
320 |
169 |
$4K |
| 0134A |
|
711 |
78 |
$4K |
| 82120 |
|
1,412 |
779 |
$3K |
| 85018 |
|
1,501 |
970 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
201 |
$3K |
| 0012A |
|
49 |
49 |
$3K |
| 90480 |
|
111 |
60 |
$3K |
| 90715 |
|
386 |
277 |
$3K |
| 86803 |
|
308 |
173 |
$3K |
| 90651 |
|
108 |
91 |
$3K |
| 81025 |
|
567 |
285 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
23 |
15 |
$3K |
| 0124A |
|
425 |
37 |
$3K |
| 0011A |
|
45 |
45 |
$2K |
| 0004A |
|
51 |
40 |
$2K |
| 0054A |
|
96 |
40 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
24 |
24 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
52 |
37 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| 99383 |
|
22 |
13 |
$2K |
| 91320 |
|
39 |
19 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
39 |
$1K |
| 81002 |
|
571 |
352 |
$1K |
| 90734 |
|
498 |
318 |
$1K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
51 |
49 |
$985.32 |
| 90658 |
|
181 |
75 |
$848.65 |
| 99401 |
|
55 |
29 |
$820.55 |
| 96160 |
|
431 |
242 |
$752.37 |
| 91322 |
|
40 |
15 |
$584.20 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
238 |
123 |
$499.82 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
159 |
116 |
$428.34 |
| 90686 |
|
1,273 |
1,016 |
$347.17 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
127 |
82 |
$312.74 |
| 87340 |
|
26 |
18 |
$201.11 |
| 90670 |
|
71 |
67 |
$190.91 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
16 |
12 |
$149.36 |
| 82950 |
|
67 |
27 |
$144.96 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
44 |
28 |
$132.16 |
| 96161 |
|
60 |
43 |
$131.64 |
| 86592 |
|
163 |
120 |
$76.04 |
| 92587 |
|
84 |
78 |
$30.08 |
| 91300 |
|
140 |
89 |
$28.07 |
| 99173 |
|
120 |
104 |
$24.81 |
| 91307 |
|
275 |
149 |
$8.19 |
| 91305 |
|
165 |
56 |
$0.00 |
| D3120 |
|
83 |
40 |
$0.00 |
| 3074F |
|
42 |
29 |
$0.00 |
| 90656 |
|
93 |
66 |
$0.00 |
| 90677 |
|
32 |
18 |
$0.00 |
| 3079F |
|
37 |
27 |
$0.00 |
| 90647 |
|
70 |
57 |
$0.00 |
| 90723 |
|
22 |
13 |
$0.00 |
| 0500F |
|
22 |
12 |
$0.00 |
| 91306 |
|
15 |
14 |
$0.00 |
| 91301 |
|
30 |
29 |
$0.00 |
| 99072 |
|
611 |
542 |
$0.00 |
| 91313 |
|
709 |
78 |
$0.00 |
| 90633 |
|
49 |
41 |
$0.00 |
| 90710 |
|
60 |
27 |
$0.00 |
| 90700 |
|
14 |
12 |
$0.00 |
| 91312 |
|
426 |
37 |
$0.00 |