| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
706,967 |
687,763 |
$3.49M |
| 99502 |
|
1,781 |
1,457 |
$103K |
| 99501 |
|
1,624 |
1,257 |
$82K |
| T1002 |
Rn services, up to 15 minutes |
2,423 |
1,806 |
$60K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,609 |
2,104 |
$59K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,017 |
2,254 |
$34K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,488 |
2,555 |
$31K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,635 |
1,249 |
$31K |
| 81025 |
|
4,654 |
3,521 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
378 |
311 |
$29K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,458 |
1,117 |
$28K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
263 |
196 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
464 |
323 |
$24K |
| D1351 |
Sealant - per tooth |
865 |
137 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
414 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
89 |
$16K |
| D1120 |
Prophylaxis - child |
542 |
477 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
79 |
$13K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
106 |
82 |
$13K |
| 87210 |
|
3,000 |
2,414 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
602 |
512 |
$9K |
| 82120 |
|
2,750 |
2,205 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
577 |
498 |
$8K |
| D0272 |
Bitewings - two radiographic images |
482 |
419 |
$8K |
| 99401 |
|
285 |
166 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
515 |
440 |
$6K |
| 96127 |
|
1,487 |
1,130 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
2,683 |
2,182 |
$5K |
| 90651 |
|
710 |
535 |
$3K |
| 81003 |
|
605 |
471 |
$1K |
| 90715 |
|
895 |
655 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
12 |
$1K |
| 85018 |
|
423 |
368 |
$1K |
| 90686 |
|
190 |
159 |
$645.50 |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
15 |
12 |
$550.00 |
| D0120 |
Periodic oral evaluation - established patient |
18 |
18 |
$536.22 |
| 86592 |
|
87 |
79 |
$486.19 |
| 90656 |
|
38 |
38 |
$393.83 |
| 82951 |
|
28 |
26 |
$311.03 |
| 90734 |
|
660 |
414 |
$241.90 |
| 90620 |
|
215 |
182 |
$210.00 |
| 90619 |
|
772 |
643 |
$171.22 |
| 82950 |
|
32 |
26 |
$132.88 |
| 86580 |
|
33 |
12 |
$39.13 |
| 90658 |
|
23 |
14 |
$22.60 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
13 |
12 |
$4.32 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
37 |
33 |
$3.90 |
| 99000 |
|
157 |
145 |
$0.00 |
| 90696 |
|
17 |
17 |
$0.00 |
| 90710 |
|
36 |
33 |
$0.00 |
| 90633 |
|
15 |
15 |
$0.00 |