| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
42,237 |
32,491 |
$1.37M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31,533 |
23,506 |
$1.09M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
11,111 |
7,904 |
$624K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15,750 |
11,682 |
$623K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
9,609 |
7,639 |
$623K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,718 |
4,783 |
$369K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17,459 |
13,657 |
$271K |
| D1206 |
Topical application of fluoride varnish |
12,534 |
11,708 |
$230K |
| D1120 |
Prophylaxis - child |
7,519 |
6,980 |
$221K |
| D1110 |
Prophylaxis - adult |
5,514 |
5,219 |
$208K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,502 |
2,056 |
$171K |
| 99215 |
Prolong outpt/office vis |
2,573 |
1,805 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
6,715 |
6,254 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,768 |
5,473 |
$143K |
| H0016 |
Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) |
735 |
539 |
$126K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,883 |
7,366 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,846 |
1,154 |
$99K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,309 |
2,339 |
$72K |
| 92557 |
|
2,175 |
1,863 |
$68K |
| D0274 |
Bitewings - four radiographic images |
3,103 |
2,986 |
$68K |
| 90961 |
|
2,596 |
1,979 |
$56K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,535 |
2,920 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
576 |
311 |
$45K |
| 96127 |
|
12,396 |
10,041 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
657 |
472 |
$42K |
| 96161 |
|
8,023 |
5,541 |
$38K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
985 |
822 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
64 |
51 |
$32K |
| 90697 |
|
1,355 |
1,013 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
617 |
246 |
$32K |
| 70450 |
Computed tomography, head or brain; without contrast material |
1,918 |
1,569 |
$30K |
| 90832 |
Psychotherapy, 30 minutes with patient |
793 |
566 |
$24K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
945 |
735 |
$24K |
| D1351 |
Sealant - per tooth |
1,062 |
283 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
537 |
519 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,383 |
1,305 |
$21K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
380 |
347 |
$21K |
| D0330 |
Panoramic radiographic image |
862 |
827 |
$20K |
| 99442 |
|
1,113 |
755 |
$20K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
625 |
527 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,089 |
1,019 |
$19K |
| 90461 |
|
8,528 |
6,181 |
$19K |
| 71045 |
Radiologic examination, chest; single view |
6,178 |
4,111 |
$18K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
1,261 |
951 |
$18K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
413 |
349 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,485 |
1,381 |
$16K |
| 87428 |
|
358 |
283 |
$15K |
| D1354 |
|
2,965 |
506 |
$14K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
223 |
197 |
$14K |
| 92558 |
|
4,070 |
3,309 |
$14K |
| 99401 |
|
1,283 |
628 |
$13K |
| 99460 |
|
331 |
268 |
$13K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
2,383 |
1,327 |
$13K |
| 3008F |
|
25,964 |
17,976 |
$13K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
467 |
374 |
$13K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
851 |
763 |
$12K |
| 90962 |
|
840 |
606 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
419 |
345 |
$11K |
| 71046 |
Radiologic examination, chest; 2 views |
2,336 |
2,000 |
$10K |
| 99205 |
Prolong outpt/office vis |
99 |
78 |
$10K |
| 88307 |
|
195 |
161 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,049 |
443 |
$9K |
| 90837 |
Psychotherapy, 53 minutes with patient |
124 |
115 |
$9K |
| 99462 |
|
515 |
259 |
$9K |
| 99443 |
|
408 |
239 |
$8K |
| 81003 |
|
5,140 |
3,533 |
$8K |
| 3078F |
|
11,427 |
8,207 |
$7K |
| 3074F |
|
12,177 |
8,894 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
163 |
110 |
$6K |
| 99441 |
|
519 |
343 |
$6K |
| 1126F |
|
13,241 |
9,495 |
$6K |
| 92552 |
|
348 |
285 |
$6K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
1,570 |
1,012 |
$6K |
| 90670 |
|
6,395 |
4,693 |
$5K |
| 90836 |
|
218 |
181 |
$5K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
229 |
170 |
$5K |
| 83655 |
|
692 |
475 |
$5K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
169 |
144 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
2,495 |
1,869 |
$5K |
| 92551 |
|
624 |
509 |
$5K |
| 3079F |
|
5,523 |
4,024 |
$5K |
| 90677 |
|
1,105 |
939 |
$5K |
| 36416 |
|
12,074 |
8,333 |
$4K |
| 99177 |
|
4,753 |
3,844 |
$4K |
| 71250 |
|
230 |
189 |
$4K |
| 99385 |
|
63 |
50 |
$4K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
277 |
238 |
$4K |
| 3077F |
|
3,986 |
2,743 |
$4K |
| 85018 |
|
2,190 |
1,591 |
$4K |
| 81002 |
|
1,857 |
1,339 |
$4K |
| 90734 |
|
569 |
392 |
$3K |
| 92250 |
|
174 |
87 |
$3K |
| 73564 |
|
582 |
453 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
88 |
73 |
$3K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,112 |
767 |
$3K |
| 99223 |
Prolong inpt eval add15 m |
53 |
38 |
$3K |
| 3080F |
|
2,484 |
1,826 |
$3K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
117 |
55 |
$3K |
| 92587 |
|
206 |
143 |
$2K |
| 99384 |
|
31 |
25 |
$2K |
| 81025 |
|
500 |
391 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
12 |
$2K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
100 |
81 |
$2K |
| 76801 |
|
47 |
40 |
$2K |
| D4341 |
|
31 |
12 |
$2K |
| 3075F |
|
2,485 |
1,826 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
96 |
$2K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
41 |
30 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
34 |
25 |
$2K |
| 99233 |
Prolong inpt eval add15 m |
60 |
24 |
$2K |
| 99217 |
|
67 |
53 |
$2K |
| 73630 |
|
425 |
313 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
18 |
12 |
$1K |
| 90686 |
|
6,129 |
5,154 |
$1K |
| 1125F |
|
1,705 |
1,189 |
$1K |
| 96160 |
|
437 |
313 |
$1K |
| 99383 |
|
16 |
14 |
$1K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
51 |
39 |
$1K |
| 73030 |
|
337 |
234 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
102 |
90 |
$1K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
46 |
40 |
$1K |
| 90651 |
|
1,386 |
1,126 |
$1K |
| 99173 |
|
2,184 |
1,899 |
$1K |
| 73130 |
|
232 |
193 |
$1K |
| 72100 |
|
208 |
182 |
$1K |
| 99382 |
|
21 |
14 |
$904.58 |
| 93970 |
|
60 |
50 |
$869.03 |
| 82962 |
|
509 |
363 |
$783.83 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
40 |
$738.00 |
| 73610 |
|
173 |
138 |
$703.55 |
| 90474 |
|
65 |
55 |
$564.87 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
198 |
126 |
$551.86 |
| 74022 |
|
68 |
64 |
$538.43 |
| 90698 |
|
1,276 |
881 |
$509.24 |
| 93971 |
|
62 |
54 |
$502.65 |
| 90681 |
|
1,239 |
970 |
$483.10 |
| 90633 |
|
1,889 |
1,439 |
$471.44 |
| 99381 |
|
20 |
13 |
$460.60 |
| 90756 |
|
183 |
150 |
$432.81 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
49 |
38 |
$383.68 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
34 |
26 |
$381.50 |
| 90658 |
|
101 |
62 |
$347.84 |
| 76830 |
Ultrasound, transvaginal |
17 |
13 |
$346.65 |
| 1159F |
|
2,045 |
1,445 |
$330.00 |
| 87210 |
|
124 |
68 |
$325.45 |
| 90620 |
|
46 |
41 |
$247.44 |
| 74018 |
|
73 |
57 |
$231.02 |
| 80305 |
|
76 |
50 |
$229.97 |
| 90619 |
|
204 |
180 |
$156.11 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
55 |
28 |
$148.96 |
| 73110 |
|
34 |
29 |
$121.22 |
| 90688 |
|
757 |
503 |
$116.78 |
| 90744 |
|
598 |
389 |
$94.35 |
| 90674 |
|
97 |
80 |
$81.91 |
| 72040 |
|
12 |
12 |
$73.34 |
| 1160F |
|
860 |
646 |
$60.00 |
| 90687 |
|
757 |
573 |
$57.77 |
| 73502 |
|
15 |
12 |
$48.08 |
| 90685 |
|
385 |
280 |
$37.32 |
| 81001 |
|
396 |
268 |
$34.02 |
| 90656 |
|
50 |
27 |
$14.19 |
| D0240 |
|
15 |
12 |
$12.68 |
| 1170F |
|
78 |
38 |
$10.00 |
| 0503F |
|
26 |
13 |
$10.00 |
| V5008 |
Hearing screening |
41 |
34 |
$0.34 |
| 2001F |
|
103 |
75 |
$0.00 |
| 1220F |
|
281 |
194 |
$0.00 |
| 90680 |
|
307 |
156 |
$0.00 |
| 2000F |
|
274 |
196 |
$0.00 |
| 90716 |
|
343 |
214 |
$0.00 |
| 3044F |
|
46 |
36 |
$0.00 |
| 90723 |
|
311 |
274 |
$0.00 |
| D1330 |
|
57 |
57 |
$0.00 |
| 4037F |
|
65 |
54 |
$0.00 |
| 1000F |
|
71 |
47 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
36 |
24 |
$0.00 |
| 90696 |
|
120 |
76 |
$0.00 |
| M1008 |
<50% of total number of a patient's outpatient ra encounters assessed |
12 |
12 |
$0.00 |
| 1157F |
|
27 |
13 |
$0.00 |
| 1123F |
|
29 |
14 |
$0.00 |
| 90648 |
|
937 |
745 |
$0.00 |
| 90700 |
|
91 |
63 |
$0.00 |
| 90710 |
|
157 |
131 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
275 |
186 |
$0.00 |
| 90473 |
|
31 |
13 |
$0.00 |
| 90707 |
|
323 |
200 |
$0.00 |
| 90655 |
|
82 |
45 |
$0.00 |
| 90715 |
|
326 |
220 |
$0.00 |
| 90672 |
|
163 |
115 |
$0.00 |
| 5250F |
|
16 |
14 |
$0.00 |
| 90621 |
|
40 |
24 |
$0.00 |
| 1158F |
|
27 |
13 |
$0.00 |
| 1124F |
|
29 |
14 |
$0.00 |
| 3016F |
|
20 |
12 |
$0.00 |
| 90380 |
|
12 |
12 |
$0.00 |