| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,060 |
9,926 |
$395K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
2,972 |
2,004 |
$267K |
| D0330 |
Panoramic radiographic image |
2,169 |
2,003 |
$110K |
| D1120 |
Prophylaxis - child |
2,758 |
2,740 |
$101K |
| D1110 |
Prophylaxis - adult |
1,667 |
1,655 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,036 |
873 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
4,072 |
3,993 |
$59K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
894 |
835 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,122 |
2,062 |
$46K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
631 |
573 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
753 |
613 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
2,581 |
2,425 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,893 |
1,755 |
$23K |
| D1351 |
Sealant - per tooth |
1,970 |
627 |
$20K |
| D1310 |
|
4,377 |
4,343 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
217 |
$10K |
| 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 |
676 |
507 |
$8K |
| D0603 |
|
226 |
225 |
$7K |
| D1330 |
|
5,198 |
5,151 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
157 |
142 |
$7K |
| D0191 |
|
606 |
603 |
$6K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
335 |
317 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
785 |
659 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
110 |
101 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
67 |
66 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
36 |
$4K |
| D0272 |
Bitewings - two radiographic images |
2,739 |
2,625 |
$3K |
| 90832 |
Psychotherapy, 30 minutes with patient |
71 |
49 |
$3K |
| 92552 |
|
322 |
319 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
30 |
28 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
51 |
44 |
$2K |
| D1206 |
Topical application of fluoride varnish |
5,593 |
5,549 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$878.36 |
| D0220 |
Intraoral - periapical first radiographic image |
2,443 |
2,382 |
$794.41 |
| 99406 |
|
156 |
136 |
$539.47 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
125 |
119 |
$517.10 |
| D1320 |
|
1,543 |
1,405 |
$481.49 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
86 |
85 |
$315.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
67 |
66 |
$310.47 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
74 |
67 |
$215.60 |
| 90686 |
|
153 |
132 |
$192.75 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
44 |
43 |
$146.52 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
51 |
50 |
$104.71 |
| 85018 |
|
54 |
52 |
$30.78 |
| D3120 |
|
226 |
207 |
$30.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
13 |
13 |
$24.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
896 |
894 |
$21.00 |
| 92551 |
|
326 |
287 |
$10.97 |
| 96127 |
|
201 |
170 |
$10.00 |
| 94760 |
|
29 |
23 |
$2.75 |
| 3008F |
|
386 |
368 |
$0.00 |
| 90651 |
|
79 |
67 |
$0.00 |
| 90688 |
|
29 |
25 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
45 |
40 |
$0.00 |
| 99177 |
|
376 |
359 |
$0.00 |
| D0270 |
|
151 |
150 |
$0.00 |
| D0180 |
|
31 |
31 |
$0.00 |
| D9910 |
|
65 |
58 |
$0.00 |
| 90461 |
|
104 |
68 |
$0.00 |
| 90734 |
|
33 |
25 |
$0.00 |
| 90633 |
|
19 |
14 |
$0.00 |