| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,906 |
2,403 |
$56K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
972 |
793 |
$24K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,038 |
373 |
$18K |
| D0330 |
Panoramic radiographic image |
226 |
220 |
$8K |
| 90837 |
Psychotherapy, 53 minutes with patient |
129 |
55 |
$6K |
| 81025 |
|
1,582 |
1,197 |
$5K |
| 81002 |
|
3,381 |
2,280 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
191 |
$5K |
| 96156 |
|
198 |
137 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
53 |
52 |
$3K |
| D1120 |
Prophylaxis - child |
115 |
111 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
36 |
26 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
33 |
28 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
44 |
40 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
37 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
60 |
59 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
40 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
33 |
32 |
$811.37 |
| 90791 |
Psychiatric diagnostic evaluation |
15 |
14 |
$774.37 |
| 92551 |
|
122 |
85 |
$692.24 |
| 99383 |
|
12 |
12 |
$627.98 |
| D1110 |
Prophylaxis - adult |
16 |
14 |
$547.56 |
| D1206 |
Topical application of fluoride varnish |
27 |
26 |
$520.70 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
44 |
37 |
$514.43 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
58 |
41 |
$478.54 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
39 |
25 |
$394.34 |
| 99173 |
|
95 |
66 |
$295.43 |
| 90674 |
|
18 |
14 |
$210.70 |
| 90658 |
|
53 |
47 |
$175.76 |
| 85018 |
|
80 |
63 |
$94.85 |
| 85014 |
|
15 |
12 |
$6.63 |
| 90461 |
|
128 |
88 |
$6.30 |
| 90700 |
|
43 |
41 |
$0.00 |
| 90713 |
|
61 |
58 |
$0.00 |
| 90670 |
|
16 |
15 |
$0.00 |
| 0502F |
|
21 |
12 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| 99000 |
|
14 |
12 |
$0.00 |
| 90647 |
|
18 |
17 |
$0.00 |