| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,945 |
6,067 |
$335K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,301 |
3,086 |
$199K |
| D1110 |
Prophylaxis - adult |
1,226 |
1,223 |
$45K |
| 90834 |
Psychotherapy, 45 minutes with patient |
646 |
512 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
416 |
165 |
$26K |
| 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 |
1,516 |
1,227 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,121 |
1,117 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,101 |
1,073 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
272 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
769 |
764 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
885 |
881 |
$15K |
| D1120 |
Prophylaxis - child |
419 |
416 |
$10K |
| D0274 |
Bitewings - four radiographic images |
392 |
389 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
89 |
$8K |
| 87428 |
|
350 |
337 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
834 |
824 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
93 |
$7K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
185 |
183 |
$6K |
| 90686 |
|
335 |
327 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
235 |
225 |
$3K |
| 3008F |
|
1,083 |
1,032 |
$3K |
| 1000F |
|
978 |
942 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
27 |
$2K |
| 1034F |
|
221 |
209 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
37 |
36 |
$1K |
| 1036F |
|
475 |
448 |
$875.00 |
| 3351F |
|
515 |
491 |
$825.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
277 |
265 |
$652.03 |
| 99177 |
|
120 |
117 |
$495.23 |
| 4000F |
|
29 |
28 |
$450.00 |
| 99000 |
|
617 |
581 |
$404.98 |
| 3078F |
|
97 |
94 |
$400.00 |
| 36415 |
Collection of venous blood by venipuncture |
273 |
242 |
$382.99 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
29 |
28 |
$375.06 |
| 3074F |
|
153 |
147 |
$350.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
26 |
$261.54 |
| 3017F |
|
14 |
13 |
$125.00 |
| 3079F |
|
15 |
13 |
$100.00 |
| 99173 |
|
13 |
13 |
$28.13 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
29 |
27 |
$21.90 |
| 91301 |
|
32 |
31 |
$0.29 |
| 1170F |
|
74 |
71 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
18 |
12 |
$0.00 |