| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,351 |
4,907 |
$935K |
| D1206 |
Topical application of fluoride varnish |
5,020 |
4,552 |
$351K |
| D0120 |
Periodic oral evaluation - established patient |
1,384 |
1,274 |
$199K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
839 |
772 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
703 |
654 |
$103K |
| D1351 |
Sealant - per tooth |
4,639 |
1,014 |
$103K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
532 |
525 |
$96K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
544 |
531 |
$94K |
| 90832 |
Psychotherapy, 30 minutes with patient |
542 |
456 |
$67K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
455 |
447 |
$63K |
| D1120 |
Prophylaxis - child |
1,660 |
1,529 |
$44K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,980 |
2,877 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
863 |
513 |
$38K |
| 99383 |
|
146 |
143 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
456 |
294 |
$23K |
| 99384 |
|
131 |
131 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,130 |
1,835 |
$17K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
122 |
117 |
$17K |
| D1110 |
Prophylaxis - adult |
376 |
342 |
$11K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
64 |
64 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
26 |
$5K |
| D0272 |
Bitewings - two radiographic images |
928 |
887 |
$4K |
| 99382 |
|
27 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
728 |
626 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
12 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
590 |
538 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
121 |
120 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,086 |
1,362 |
$1K |
| 90651 |
|
208 |
202 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
13 |
$506.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
201 |
196 |
$371.50 |
| 90686 |
|
943 |
909 |
$337.50 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
27 |
25 |
$332.84 |
| 85018 |
|
47 |
44 |
$166.42 |
| 90696 |
|
25 |
25 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
403 |
387 |
$0.00 |
| 99000 |
|
80 |
77 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
16 |
16 |
$0.00 |
| 90723 |
|
87 |
84 |
$0.00 |
| D0603 |
|
208 |
138 |
$0.00 |
| 90647 |
|
98 |
95 |
$0.00 |
| D1330 |
|
34 |
25 |
$0.00 |
| V5008 |
Hearing screening |
14 |
14 |
$0.00 |
| D1310 |
|
31 |
23 |
$0.00 |
| 90656 |
|
38 |
38 |
$0.00 |
| 87428 |
|
38 |
35 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |
| D1353 |
|
106 |
33 |
$0.00 |
| D0240 |
|
24 |
14 |
$0.00 |
| 90688 |
|
15 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
23 |
19 |
$0.00 |
| 90620 |
|
13 |
12 |
$0.00 |
| D0191 |
|
777 |
771 |
$0.00 |
| 90461 |
|
1,352 |
1,312 |
$0.00 |
| 83655 |
|
48 |
45 |
$0.00 |
| D0190 |
|
1,705 |
1,514 |
$0.00 |
| 90710 |
|
76 |
74 |
$0.00 |
| D1354 |
|
123 |
52 |
$0.00 |
| 90685 |
|
52 |
52 |
$0.00 |
| 90670 |
|
147 |
142 |
$0.00 |
| 90734 |
|
189 |
184 |
$0.00 |
| 90633 |
|
79 |
77 |
$0.00 |
| 90715 |
|
53 |
51 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
19 |
15 |
$0.00 |
| 90681 |
|
12 |
12 |
$0.00 |