| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,595 |
8,917 |
$1.58M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,647 |
2,955 |
$531K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,354 |
2,054 |
$340K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,003 |
612 |
$107K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,745 |
2,706 |
$94K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
872 |
520 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,239 |
826 |
$79K |
| 99442 |
|
600 |
362 |
$62K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
415 |
228 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
290 |
$36K |
| 90837 |
Psychotherapy, 53 minutes with patient |
249 |
62 |
$35K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
268 |
161 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
331 |
177 |
$26K |
| 90834 |
Psychotherapy, 45 minutes with patient |
152 |
38 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,227 |
1,125 |
$17K |
| D0274 |
Bitewings - four radiographic images |
652 |
608 |
$15K |
| D1110 |
Prophylaxis - adult |
287 |
287 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
61 |
$13K |
| 90461 |
|
325 |
325 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
177 |
91 |
$11K |
| 99441 |
|
112 |
58 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
103 |
54 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
598 |
587 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
88 |
66 |
$7K |
| 90686 |
|
1,637 |
1,636 |
$7K |
| 0012A |
|
174 |
174 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
26 |
$6K |
| 0071A |
|
144 |
133 |
$6K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
170 |
166 |
$6K |
| 0011A |
|
182 |
182 |
$5K |
| 0001A |
|
128 |
126 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
692 |
643 |
$5K |
| 0002A |
|
116 |
116 |
$5K |
| 99173 |
|
1,615 |
1,613 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
40 |
25 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
89 |
$4K |
| 82962 |
|
265 |
162 |
$4K |
| 90832 |
Psychotherapy, 30 minutes with patient |
30 |
12 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
42 |
26 |
$3K |
| 81025 |
|
596 |
578 |
$3K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
35 |
33 |
$3K |
| 99443 |
|
24 |
14 |
$3K |
| 81000 |
|
636 |
463 |
$2K |
| 97803 |
|
53 |
48 |
$2K |
| 90750 |
|
13 |
13 |
$2K |
| 92551 |
|
229 |
229 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
1,964 |
1,899 |
$2K |
| 1000F |
|
1,972 |
1,944 |
$2K |
| 97802 |
|
18 |
18 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$727.50 |
| 0064A |
|
15 |
15 |
$613.86 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
25 |
$602.60 |
| 96161 |
|
334 |
331 |
$272.05 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$174.37 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$137.27 |
| D0270 |
|
13 |
13 |
$120.60 |
| 86580 |
|
13 |
13 |
$111.93 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
13 |
13 |
$96.36 |
| 92015 |
Determination of refractive state |
26 |
26 |
$60.80 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
13 |
13 |
$40.00 |
| 99000 |
|
1,855 |
1,832 |
$0.00 |
| 91301 |
|
168 |
163 |
$0.00 |
| 91307 |
|
82 |
73 |
$0.00 |
| 91300 |
|
188 |
168 |
$0.00 |
| 90649 |
|
14 |
14 |
$0.00 |