| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,959 |
2,730 |
$476K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,062 |
963 |
$157K |
| 99403 |
|
653 |
582 |
$89K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
588 |
541 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,427 |
202 |
$72K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,818 |
1,682 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
683 |
117 |
$47K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
6,666 |
6,408 |
$38K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
184 |
182 |
$31K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
9,050 |
8,793 |
$24K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
107 |
99 |
$16K |
| 90715 |
|
1,723 |
1,684 |
$10K |
| 90696 |
|
1,112 |
1,080 |
$8K |
| 90723 |
|
572 |
563 |
$7K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
59 |
41 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
14 |
$6K |
| 90686 |
|
2,505 |
2,456 |
$5K |
| 90698 |
|
559 |
550 |
$5K |
| 90633 |
|
2,557 |
2,515 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
890 |
70 |
$4K |
| 90670 |
|
1,735 |
1,711 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
17 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$2K |
| 90700 |
|
259 |
256 |
$2K |
| 90734 |
|
757 |
740 |
$2K |
| 90651 |
|
1,908 |
1,866 |
$1K |
| 90672 |
|
290 |
288 |
$1K |
| 90647 |
|
486 |
481 |
$998.59 |
| D1206 |
Topical application of fluoride varnish |
348 |
61 |
$941.34 |
| D1110 |
Prophylaxis - adult |
78 |
13 |
$889.14 |
| 90710 |
|
2,294 |
2,250 |
$733.99 |
| 90744 |
|
124 |
124 |
$530.25 |
| 90697 |
|
333 |
322 |
$132.00 |
| 90619 |
|
543 |
531 |
$129.88 |
| 90620 |
|
30 |
29 |
$93.50 |
| 90680 |
|
70 |
70 |
$93.50 |
| 90681 |
|
24 |
24 |
$88.29 |
| 90707 |
|
63 |
63 |
$33.00 |
| 90716 |
|
56 |
56 |
$22.00 |
| D1330 |
|
274 |
48 |
$0.00 |
| 90677 |
|
64 |
62 |
$0.00 |
| 90656 |
|
38 |
37 |
$0.00 |
| 90671 |
|
195 |
188 |
$0.00 |
| 90713 |
|
15 |
15 |
$0.00 |
| 90661 |
|
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
156 |
26 |
$0.00 |