| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,813 |
4,219 |
$140K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,124 |
1,000 |
$66K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,107 |
975 |
$66K |
| 90834 |
Psychotherapy, 45 minutes with patient |
965 |
672 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
816 |
729 |
$31K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
418 |
390 |
$26K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
219 |
185 |
$14K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
969 |
857 |
$12K |
| 90671 |
|
245 |
219 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,885 |
1,662 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,195 |
1,051 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
95 |
88 |
$5K |
| D1330 |
|
398 |
396 |
$3K |
| 90670 |
|
455 |
377 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
155 |
93 |
$2K |
| 90461 |
|
398 |
350 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
134 |
134 |
$1K |
| D1206 |
Topical application of fluoride varnish |
384 |
379 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
24 |
$1K |
| 92558 |
|
177 |
174 |
$1K |
| 99401 |
|
80 |
70 |
$1K |
| 99381 |
|
14 |
12 |
$995.30 |
| 81025 |
|
395 |
356 |
$918.21 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
34 |
$895.66 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
12 |
$838.59 |
| 83655 |
|
140 |
138 |
$800.27 |
| D1120 |
Prophylaxis - child |
75 |
74 |
$783.76 |
| 36415 |
Collection of venous blood by venipuncture |
1,177 |
1,073 |
$614.83 |
| 99384 |
|
18 |
16 |
$543.86 |
| 3078F |
|
4,071 |
3,544 |
$523.39 |
| 90661 |
|
43 |
40 |
$414.09 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$335.85 |
| 90686 |
|
309 |
282 |
$287.52 |
| 3074F |
|
4,475 |
4,075 |
$275.00 |
| 90651 |
|
116 |
99 |
$270.57 |
| 85018 |
|
292 |
275 |
$249.89 |
| 90710 |
|
32 |
24 |
$247.52 |
| 90474 |
|
85 |
72 |
$220.00 |
| H1000 |
Prenatal care, at-risk assessment |
112 |
45 |
$216.10 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$188.16 |
| 90716 |
|
44 |
40 |
$155.73 |
| 90697 |
|
312 |
284 |
$149.82 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$79.44 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$75.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$67.20 |
| 81002 |
|
71 |
61 |
$53.31 |
| 3075F |
|
136 |
125 |
$50.00 |
| 90674 |
|
100 |
93 |
$40.00 |
| 90656 |
|
67 |
60 |
$39.52 |
| 90633 |
|
300 |
250 |
$36.92 |
| 82962 |
|
19 |
15 |
$12.53 |
| D0191 |
|
51 |
51 |
$10.45 |
| 3008F |
|
6,229 |
5,360 |
$0.01 |
| 2000F |
|
5,647 |
4,825 |
$0.00 |
| 2010F |
|
274 |
250 |
$0.00 |
| 1055F |
|
41 |
41 |
$0.00 |
| 96127 |
|
67 |
61 |
$0.00 |
| 1220F |
|
1,914 |
1,753 |
$0.00 |
| 4000F |
|
1,914 |
1,727 |
$0.00 |
| 3044F |
|
336 |
300 |
$0.00 |
| 92551 |
|
62 |
62 |
$0.00 |
| 2001F |
|
8,355 |
7,111 |
$0.00 |
| 3079F |
|
703 |
588 |
$0.00 |
| 1000F |
|
4,126 |
3,683 |
$0.00 |
| 1126F |
|
443 |
391 |
$0.00 |
| 1157F |
|
196 |
110 |
$0.00 |
| D0601 |
|
66 |
64 |
$0.00 |
| 4060F |
|
153 |
36 |
$0.00 |
| D0603 |
|
44 |
43 |
$0.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
158 |
40 |
$0.00 |
| D1310 |
|
115 |
115 |
$0.00 |
| 36416 |
|
32 |
24 |
$0.00 |
| 90698 |
|
30 |
27 |
$0.00 |
| 1036F |
|
43 |
42 |
$0.00 |
| 90696 |
|
30 |
25 |
$0.00 |
| 90677 |
|
36 |
34 |
$0.00 |
| 4010F |
|
17 |
16 |
$0.00 |
| 1159F |
|
5,189 |
4,594 |
$0.00 |
| 99173 |
|
354 |
323 |
$0.00 |
| 3077F |
|
26 |
24 |
$0.00 |
| 1160F |
|
5,178 |
4,585 |
$0.00 |
| 90681 |
|
159 |
136 |
$0.00 |
| 90707 |
|
14 |
13 |
$0.00 |
| 90715 |
|
14 |
12 |
$0.00 |