| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33,047 |
21,927 |
$2.42M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,256 |
5,514 |
$559K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,513 |
2,814 |
$399K |
| 99441 |
|
3,491 |
2,442 |
$224K |
| D1110 |
Prophylaxis - adult |
3,073 |
1,819 |
$117K |
| 99442 |
|
1,507 |
942 |
$115K |
| 90837 |
Psychotherapy, 53 minutes with patient |
620 |
261 |
$70K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
992 |
659 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,593 |
597 |
$45K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
823 |
529 |
$45K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
522 |
322 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,982 |
1,289 |
$33K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,100 |
2,079 |
$30K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
509 |
329 |
$27K |
| 90834 |
Psychotherapy, 45 minutes with patient |
277 |
130 |
$26K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
331 |
215 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
675 |
402 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
450 |
226 |
$21K |
| D0274 |
Bitewings - four radiographic images |
775 |
572 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
143 |
$12K |
| 92551 |
|
2,034 |
2,032 |
$10K |
| 87110 |
|
898 |
892 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
46 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
586 |
574 |
$4K |
| 0011A |
|
126 |
126 |
$3K |
| 0012A |
|
105 |
105 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
543 |
532 |
$3K |
| 99385 |
|
34 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
14 |
$2K |
| 99173 |
|
1,467 |
1,465 |
$2K |
| 88142 |
|
170 |
170 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
13 |
$2K |
| 99386 |
|
24 |
13 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
24 |
13 |
$2K |
| 0001A |
|
40 |
39 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
2,028 |
2,016 |
$1K |
| 0002A |
|
28 |
28 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
19 |
14 |
$1K |
| 99408 |
|
22 |
13 |
$1K |
| 81025 |
|
252 |
247 |
$1K |
| 0064A |
|
20 |
20 |
$675.13 |
| 90461 |
|
160 |
155 |
$593.76 |
| 90732 |
|
12 |
12 |
$593.30 |
| 90686 |
|
488 |
488 |
$557.59 |
| 90662 |
|
39 |
39 |
$510.00 |
| 81000 |
|
496 |
488 |
$479.66 |
| 90688 |
|
72 |
72 |
$416.31 |
| 86480 |
|
43 |
43 |
$400.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
124 |
122 |
$369.46 |
| 86580 |
|
65 |
65 |
$354.90 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$259.65 |
| 82948 |
|
27 |
24 |
$209.72 |
| 81002 |
|
66 |
47 |
$136.32 |
| 96127 |
|
34 |
29 |
$132.36 |
| D1330 |
|
151 |
149 |
$131.59 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
56 |
56 |
$125.99 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$109.40 |
| 87070 |
|
27 |
27 |
$94.96 |
| 3077F |
|
16 |
12 |
$60.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$59.26 |
| 83655 |
|
24 |
24 |
$24.95 |
| 80061 |
Lipid panel |
31 |
31 |
$24.34 |
| 83700 |
|
14 |
14 |
$15.50 |
| 3008F |
|
15,754 |
14,291 |
$0.02 |
| 86709 |
|
291 |
291 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
73 |
69 |
$0.00 |
| 3078F |
|
31 |
28 |
$0.00 |
| D1999 |
|
45 |
44 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
101 |
92 |
$0.00 |
| D0431 |
|
24 |
24 |
$0.00 |
| 86803 |
|
303 |
303 |
$0.00 |
| 86704 |
|
288 |
288 |
$0.00 |
| 86706 |
|
90 |
90 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
93 |
85 |
$0.00 |
| 3074F |
|
31 |
28 |
$0.00 |
| 3044F |
|
28 |
28 |
$0.00 |
| 3079F |
|
12 |
12 |
$0.00 |
| D1310 |
|
12 |
12 |
$0.00 |