| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
26,401 |
17,101 |
$2.80M |
| 90834 |
Psychotherapy, 45 minutes with patient |
13,521 |
6,544 |
$1.88M |
| D1120 |
Prophylaxis - child |
16,604 |
7,736 |
$1.10M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,207 |
5,589 |
$761K |
| D0120 |
Periodic oral evaluation - established patient |
7,337 |
5,305 |
$743K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,132 |
3,753 |
$592K |
| D1206 |
Topical application of fluoride varnish |
8,770 |
4,169 |
$562K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,016 |
3,420 |
$531K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,698 |
1,872 |
$365K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,018 |
2,362 |
$333K |
| D1110 |
Prophylaxis - adult |
3,127 |
1,573 |
$220K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,542 |
1,286 |
$188K |
| D0190 |
|
1,344 |
1,263 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,450 |
1,239 |
$166K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,049 |
1,651 |
$153K |
| 92551 |
|
1,876 |
1,030 |
$104K |
| D1351 |
Sealant - per tooth |
1,762 |
482 |
$68K |
| 90837 |
Psychotherapy, 53 minutes with patient |
418 |
288 |
$55K |
| 90791 |
Psychiatric diagnostic evaluation |
343 |
262 |
$47K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
879 |
303 |
$44K |
| 99443 |
|
562 |
271 |
$35K |
| D0272 |
Bitewings - two radiographic images |
425 |
235 |
$33K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
317 |
211 |
$31K |
| 96127 |
|
258 |
220 |
$28K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
98 |
38 |
$13K |
| 99441 |
|
141 |
116 |
$9K |
| D0274 |
Bitewings - four radiographic images |
48 |
46 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
67 |
44 |
$6K |
| 99442 |
|
88 |
61 |
$6K |
| T1015 |
Clinic visit/encounter, all-inclusive |
371 |
34 |
$6K |
| 99215 |
Prolong outpt/office vis |
35 |
30 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
28 |
$4K |
| 81025 |
|
61 |
52 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$2K |
| 99383 |
|
35 |
13 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
128 |
107 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$65.00 |
| 90686 |
|
118 |
118 |
$0.01 |
| 90656 |
|
26 |
26 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$0.00 |
| 99173 |
|
41 |
41 |
$0.00 |