| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
398,401 |
351,889 |
$2.08M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,411 |
1,178 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
3,684 |
3,557 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
825 |
576 |
$94K |
| D1110 |
Prophylaxis - adult |
1,981 |
1,904 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
809 |
566 |
$69K |
| D1206 |
Topical application of fluoride varnish |
3,531 |
3,414 |
$63K |
| D1120 |
Prophylaxis - child |
1,950 |
1,892 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,125 |
1,090 |
$53K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,118 |
2,639 |
$44K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
495 |
458 |
$36K |
| D0274 |
Bitewings - four radiographic images |
880 |
840 |
$31K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,241 |
1,065 |
$25K |
| 0001A |
|
414 |
372 |
$23K |
| 0002A |
|
369 |
317 |
$21K |
| D1351 |
Sealant - per tooth |
674 |
176 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
369 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
98 |
$15K |
| D0272 |
Bitewings - two radiographic images |
748 |
725 |
$15K |
| 99502 |
|
244 |
218 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
179 |
170 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
386 |
362 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
789 |
742 |
$13K |
| 99501 |
|
224 |
195 |
$11K |
| 90734 |
|
532 |
435 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
1,779 |
1,515 |
$5K |
| 81025 |
|
588 |
490 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
54 |
27 |
$4K |
| 0071A |
|
101 |
52 |
$4K |
| 0012A |
|
64 |
61 |
$3K |
| 87210 |
|
703 |
595 |
$3K |
| 0072A |
|
67 |
38 |
$3K |
| 82120 |
|
702 |
594 |
$3K |
| 96127 |
|
550 |
449 |
$2K |
| 90715 |
|
529 |
455 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
131 |
129 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
119 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| T1002 |
Rn services, up to 15 minutes |
29 |
26 |
$2K |
| D4355 |
|
26 |
25 |
$2K |
| 0011A |
|
76 |
71 |
$2K |
| 0004A |
|
23 |
16 |
$1K |
| 90686 |
|
554 |
442 |
$1K |
| 90651 |
|
122 |
115 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| 83986 |
|
444 |
365 |
$1K |
| 81002 |
|
338 |
277 |
$792.88 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
21 |
13 |
$731.09 |
| D1354 |
|
85 |
30 |
$671.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
59 |
54 |
$490.00 |
| 99406 |
|
33 |
27 |
$480.86 |
| 90619 |
|
270 |
244 |
$331.36 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
12 |
12 |
$281.52 |
| 90688 |
|
31 |
19 |
$272.67 |
| 87081 |
|
43 |
36 |
$256.33 |
| 85018 |
|
132 |
118 |
$153.60 |
| 99173 |
|
351 |
319 |
$109.38 |
| 82947 |
|
12 |
12 |
$59.88 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
119 |
118 |
$44.88 |
| 96160 |
|
12 |
12 |
$44.88 |
| 92551 |
|
104 |
95 |
$43.35 |
| 86592 |
|
118 |
117 |
$43.13 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
264 |
251 |
$16.92 |
| 99000 |
|
1,598 |
1,484 |
$0.00 |
| 3074F |
|
1,169 |
982 |
$0.00 |
| 90696 |
|
30 |
30 |
$0.00 |
| 91301 |
|
150 |
140 |
$0.00 |
| 36416 |
|
237 |
218 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
24 |
12 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
14 |
13 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
14 |
12 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
264 |
251 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
32 |
32 |
$0.00 |
| 91307 |
|
187 |
92 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
14 |
13 |
$0.00 |
| 3079F |
|
43 |
39 |
$0.00 |
| 3078F |
|
932 |
786 |
$0.00 |
| D0191 |
|
140 |
123 |
$0.00 |
| G9920 |
Screening performed and negative |
1,522 |
1,313 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
98 |
93 |
$0.00 |
| 99080 |
|
73 |
56 |
$0.00 |
| 91300 |
|
889 |
647 |
$0.00 |
| 90710 |
|
113 |
89 |
$0.00 |
| 98960 |
|
15 |
15 |
$0.00 |
| 80061 |
Lipid panel |
14 |
13 |
$0.00 |
| 3077F |
|
16 |
15 |
$0.00 |