| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
237,884 |
168,170 |
$1.34M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,737 |
4,752 |
$361K |
| D0120 |
Periodic oral evaluation - established patient |
10,474 |
10,277 |
$307K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,503 |
1,530 |
$272K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,125 |
10,945 |
$203K |
| D1110 |
Prophylaxis - adult |
4,669 |
4,601 |
$202K |
| D1120 |
Prophylaxis - child |
6,105 |
5,999 |
$189K |
| D0330 |
Panoramic radiographic image |
2,348 |
2,289 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,402 |
929 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,226 |
3,165 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
2,423 |
2,333 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,629 |
1,590 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,018 |
655 |
$78K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
645 |
555 |
$75K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
689 |
599 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,202 |
3,141 |
$66K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,276 |
1,981 |
$63K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,095 |
4,152 |
$59K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,534 |
2,165 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,812 |
2,706 |
$47K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
565 |
440 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
247 |
199 |
$36K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
400 |
351 |
$34K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
385 |
344 |
$29K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
908 |
807 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,800 |
860 |
$24K |
| D1351 |
Sealant - per tooth |
896 |
217 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
381 |
333 |
$19K |
| 0001A |
|
336 |
272 |
$15K |
| 87210 |
|
3,685 |
3,113 |
$14K |
| 81025 |
|
2,169 |
1,780 |
$14K |
| 82120 |
|
3,684 |
3,109 |
$14K |
| 0012A |
|
305 |
254 |
$13K |
| 0002A |
|
335 |
205 |
$11K |
| 0011A |
|
336 |
289 |
$11K |
| 36415 |
Collection of venous blood by venipuncture |
4,522 |
3,735 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
985 |
871 |
$7K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
318 |
251 |
$7K |
| 0071A |
|
126 |
81 |
$5K |
| 0072A |
|
86 |
71 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
29 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
290 |
140 |
$4K |
| 92551 |
|
2,767 |
2,275 |
$4K |
| 0064A |
|
85 |
66 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
267 |
247 |
$4K |
| D4355 |
|
57 |
54 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
249 |
190 |
$4K |
| 90651 |
|
622 |
499 |
$3K |
| 90837 |
Psychotherapy, 53 minutes with patient |
23 |
12 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$3K |
| 99384 |
|
33 |
27 |
$3K |
| 90686 |
|
1,506 |
1,155 |
$2K |
| 90734 |
|
859 |
711 |
$2K |
| 99383 |
|
16 |
13 |
$2K |
| T1002 |
Rn services, up to 15 minutes |
103 |
81 |
$2K |
| 85018 |
|
996 |
833 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
24 |
12 |
$1K |
| 96127 |
|
186 |
158 |
$703.31 |
| 81003 |
|
471 |
368 |
$588.30 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$534.30 |
| 87081 |
|
117 |
105 |
$491.11 |
| 90715 |
|
367 |
291 |
$445.76 |
| 90480 |
|
18 |
13 |
$408.46 |
| 0031A |
|
35 |
14 |
$341.95 |
| 96160 |
|
89 |
75 |
$243.10 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$235.80 |
| 90620 |
|
159 |
145 |
$193.05 |
| 99173 |
|
2,150 |
1,734 |
$179.16 |
| 90633 |
|
208 |
180 |
$79.28 |
| 90656 |
|
14 |
13 |
$60.00 |
| 96161 |
|
14 |
13 |
$41.14 |
| 91300 |
|
768 |
516 |
$3.68 |
| 90710 |
|
188 |
166 |
$0.00 |
| 99177 |
|
481 |
418 |
$0.00 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
156 |
134 |
$0.00 |
| 90670 |
|
129 |
109 |
$0.00 |
| 90700 |
|
14 |
14 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
745 |
633 |
$0.00 |
| 91306 |
|
82 |
64 |
$0.00 |
| 90696 |
|
43 |
40 |
$0.00 |
| 91307 |
|
224 |
143 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
77 |
61 |
$0.00 |
| 91301 |
|
701 |
583 |
$0.00 |
| 91302 |
|
32 |
14 |
$0.00 |