| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,069 |
4,853 |
$417K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,769 |
2,597 |
$144K |
| 99215 |
Prolong outpt/office vis |
174 |
171 |
$18K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,213 |
2,142 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
713 |
708 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
86 |
$12K |
| D0274 |
Bitewings - four radiographic images |
358 |
356 |
$10K |
| 80061 |
Lipid panel |
1,523 |
1,477 |
$9K |
| 90686 |
|
532 |
527 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
793 |
778 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
444 |
436 |
$7K |
| 90750 |
|
47 |
45 |
$7K |
| 99441 |
|
192 |
180 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
309 |
305 |
$5K |
| D1110 |
Prophylaxis - adult |
170 |
170 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
314 |
286 |
$4K |
| D0330 |
Panoramic radiographic image |
65 |
65 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
86 |
83 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
504 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
26 |
26 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$2K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
99 |
99 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
165 |
165 |
$1K |
| 0012A |
|
12 |
12 |
$480.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
13 |
12 |
$382.38 |
| 99442 |
|
22 |
13 |
$290.26 |
| 82274 |
|
26 |
26 |
$250.00 |
| 81003 |
|
78 |
76 |
$163.60 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
12 |
12 |
$160.04 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
17 |
$0.00 |
| 91301 |
|
48 |
47 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
586 |
173 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
16 |
$0.00 |