| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,830 |
6,239 |
$429K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,043 |
4,587 |
$217K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,164 |
4,682 |
$162K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,146 |
1,995 |
$116K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,712 |
1,621 |
$92K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,472 |
1,382 |
$89K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,907 |
1,708 |
$87K |
| 92081 |
|
4,204 |
3,934 |
$57K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
7,058 |
6,587 |
$53K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
988 |
902 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
335 |
$29K |
| 92551 |
|
4,454 |
4,162 |
$25K |
| 86403 |
|
2,913 |
2,674 |
$24K |
| D1120 |
Prophylaxis - child |
987 |
956 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,216 |
1,180 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
972 |
940 |
$16K |
| 36416 |
|
6,017 |
5,614 |
$16K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
571 |
517 |
$14K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,004 |
881 |
$12K |
| 85018 |
|
5,921 |
5,535 |
$10K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,003 |
920 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
157 |
105 |
$8K |
| 90670 |
|
1,532 |
1,426 |
$7K |
| 90633 |
|
837 |
785 |
$6K |
| 81002 |
|
1,999 |
1,899 |
$5K |
| 83655 |
|
495 |
457 |
$5K |
| D1110 |
Prophylaxis - adult |
108 |
104 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
119 |
$3K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
251 |
236 |
$3K |
| 90686 |
|
596 |
580 |
$3K |
| 90649 |
|
546 |
520 |
$2K |
| D0272 |
Bitewings - two radiographic images |
272 |
267 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
52 |
$2K |
| 90734 |
|
410 |
385 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D1351 |
Sealant - per tooth |
77 |
30 |
$2K |
| 99381 |
|
28 |
25 |
$1K |
| 90698 |
|
667 |
631 |
$1K |
| 90648 |
|
184 |
173 |
$1K |
| D0274 |
Bitewings - four radiographic images |
69 |
65 |
$1K |
| 90681 |
|
242 |
225 |
$629.00 |
| 90656 |
|
121 |
93 |
$555.00 |
| 90662 |
|
102 |
94 |
$510.00 |
| 90715 |
|
158 |
138 |
$440.00 |
| 90744 |
|
280 |
265 |
$380.00 |
| 90696 |
|
91 |
84 |
$282.00 |
| 90707 |
|
54 |
39 |
$265.00 |
| 90710 |
|
109 |
102 |
$225.00 |
| 90716 |
|
33 |
25 |
$130.00 |
| 90619 |
|
67 |
60 |
$120.00 |
| 90723 |
|
15 |
15 |
$107.50 |
| 90700 |
|
30 |
30 |
$51.00 |
| 90620 |
|
72 |
71 |
$40.00 |