| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,549 |
13,753 |
$511K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,509 |
6,372 |
$344K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,454 |
2,021 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,444 |
4,836 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
4,666 |
4,105 |
$140K |
| D1120 |
Prophylaxis - child |
3,186 |
2,942 |
$139K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,963 |
1,242 |
$128K |
| D0330 |
Panoramic radiographic image |
3,083 |
2,680 |
$109K |
| D1110 |
Prophylaxis - adult |
1,498 |
1,331 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
907 |
616 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,144 |
1,874 |
$44K |
| 90834 |
Psychotherapy, 45 minutes with patient |
871 |
648 |
$41K |
| D1206 |
Topical application of fluoride varnish |
3,212 |
2,961 |
$40K |
| D1351 |
Sealant - per tooth |
2,046 |
555 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
5,465 |
4,737 |
$35K |
| 90832 |
Psychotherapy, 30 minutes with patient |
873 |
602 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
564 |
346 |
$22K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
811 |
723 |
$20K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
334 |
293 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
961 |
883 |
$18K |
| D0272 |
Bitewings - two radiographic images |
904 |
833 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,816 |
2,192 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
182 |
$9K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
136 |
115 |
$9K |
| D4341 |
|
143 |
56 |
$8K |
| 99215 |
Prolong outpt/office vis |
90 |
79 |
$5K |
| 87428 |
|
137 |
131 |
$4K |
| T1015 |
Clinic visit/encounter, all-inclusive |
728 |
641 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
454 |
397 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
45 |
43 |
$3K |
| 81003 |
|
3,024 |
2,588 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
296 |
270 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
38 |
37 |
$3K |
| 99383 |
|
28 |
28 |
$2K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
430 |
149 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
29 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
60 |
44 |
$2K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
276 |
167 |
$2K |
| 81025 |
|
275 |
229 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
89 |
83 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
14 |
$1K |
| 99384 |
|
20 |
18 |
$1K |
| 0012A |
|
27 |
27 |
$1K |
| 90633 |
|
82 |
75 |
$975.20 |
| 0011A |
|
27 |
25 |
$910.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
24 |
12 |
$842.00 |
| 90661 |
|
21 |
21 |
$700.15 |
| 0064A |
|
21 |
20 |
$680.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28 |
27 |
$466.10 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
27 |
27 |
$416.56 |
| 36415 |
Collection of venous blood by venipuncture |
92 |
87 |
$331.64 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
25 |
22 |
$290.39 |
| 90461 |
|
44 |
37 |
$270.60 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
14 |
$251.16 |
| 86403 |
|
28 |
24 |
$238.32 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$188.25 |
| 90716 |
|
15 |
12 |
$147.20 |
| 90651 |
|
13 |
12 |
$147.20 |
| 90686 |
|
26 |
25 |
$123.75 |
| D0270 |
|
14 |
13 |
$75.15 |
| 3008F |
|
9,863 |
8,944 |
$2.25 |
| 3079F |
|
12 |
12 |
$0.00 |
| 3074F |
|
17 |
14 |
$0.00 |
| 91301 |
|
42 |
41 |
$0.00 |
| 3725F |
|
2,344 |
2,157 |
$0.00 |
| 3078F |
|
14 |
13 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |