| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
345,333 |
338,858 |
$1.69M |
| 59426 |
|
272 |
268 |
$185K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,641 |
1,498 |
$104K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
149 |
147 |
$101K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,419 |
2,955 |
$101K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,835 |
3,970 |
$63K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
282 |
265 |
$38K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,654 |
1,416 |
$36K |
| 0001A |
|
775 |
619 |
$36K |
| 0002A |
|
699 |
553 |
$34K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
718 |
507 |
$31K |
| 81025 |
|
3,644 |
3,161 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
185 |
$27K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
676 |
566 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
921 |
827 |
$21K |
| D1120 |
Prophylaxis - child |
842 |
766 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
184 |
$19K |
| D1351 |
Sealant - per tooth |
682 |
158 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,088 |
975 |
$15K |
| 0012A |
|
222 |
222 |
$13K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
237 |
221 |
$13K |
| T1002 |
Rn services, up to 15 minutes |
254 |
210 |
$12K |
| 59430 |
|
140 |
128 |
$10K |
| D1110 |
Prophylaxis - adult |
309 |
264 |
$10K |
| 0011A |
|
275 |
262 |
$10K |
| 59514 |
|
12 |
12 |
$9K |
| 90715 |
|
898 |
763 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
171 |
$8K |
| 0072A |
|
130 |
94 |
$7K |
| 90686 |
|
1,212 |
1,024 |
$6K |
| 90734 |
|
1,368 |
1,112 |
$6K |
| 96127 |
|
833 |
661 |
$6K |
| D0272 |
Bitewings - two radiographic images |
370 |
326 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
52 |
45 |
$5K |
| 0071A |
|
118 |
88 |
$5K |
| 59425 |
|
13 |
13 |
$5K |
| D0274 |
Bitewings - four radiographic images |
167 |
145 |
$5K |
| 81002 |
|
2,024 |
1,370 |
$4K |
| D0330 |
Panoramic radiographic image |
86 |
76 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
32 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
69 |
$3K |
| 85018 |
|
1,302 |
1,007 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
1,161 |
899 |
$2K |
| 90651 |
|
214 |
174 |
$2K |
| 0004A |
|
43 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
74 |
$1K |
| 0064A |
|
19 |
17 |
$1K |
| 90688 |
|
302 |
211 |
$894.75 |
| 0124A |
|
19 |
13 |
$845.00 |
| 0031A |
|
16 |
12 |
$837.62 |
| 90716 |
|
73 |
64 |
$807.39 |
| 99401 |
|
25 |
24 |
$650.58 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
12 |
$149.34 |
| 90633 |
|
69 |
60 |
$98.34 |
| 82962 |
|
63 |
51 |
$77.48 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
740 |
708 |
$63.50 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
771 |
731 |
$63.50 |
| 86703 |
|
334 |
263 |
$0.00 |
| 90713 |
|
27 |
26 |
$0.00 |
| 90710 |
|
82 |
65 |
$0.00 |
| 91300 |
|
1,677 |
1,232 |
$0.00 |
| 91312 |
|
19 |
13 |
$0.00 |
| S4993 |
Contraceptive pills for birth control |
165 |
156 |
$0.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
30 |
30 |
$0.00 |
| 90707 |
|
33 |
32 |
$0.00 |
| 90700 |
|
14 |
13 |
$0.00 |
| 90685 |
|
25 |
25 |
$0.00 |
| 86787 |
|
19 |
18 |
$0.00 |
| 91301 |
|
601 |
575 |
$0.00 |
| 91307 |
|
271 |
189 |
$0.00 |
| 90696 |
|
55 |
45 |
$0.00 |
| 91303 |
|
16 |
12 |
$0.00 |
| 87088 |
|
107 |
88 |
$0.00 |
| 86803 |
|
80 |
61 |
$0.00 |
| 80055 |
|
107 |
82 |
$0.00 |
| 85660 |
|
57 |
46 |
$0.00 |
| 86593 |
|
25 |
25 |
$0.00 |
| 86762 |
|
19 |
18 |
$0.00 |
| 91306 |
|
20 |
18 |
$0.00 |