| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
5,145 |
4,852 |
$1.03M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,289 |
15,861 |
$1.02M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,385 |
9,430 |
$900K |
| D1120 |
Prophylaxis - child |
15,457 |
14,347 |
$404K |
| D0120 |
Periodic oral evaluation - established patient |
17,137 |
15,886 |
$299K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,586 |
1,866 |
$249K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,813 |
14,611 |
$216K |
| D1999 |
|
12,289 |
10,080 |
$208K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,701 |
2,532 |
$176K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,450 |
2,315 |
$154K |
| D0330 |
Panoramic radiographic image |
3,429 |
3,143 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,484 |
6,577 |
$146K |
| D0272 |
Bitewings - two radiographic images |
7,742 |
7,152 |
$128K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,264 |
1,759 |
$127K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,069 |
1,961 |
$124K |
| D1351 |
Sealant - per tooth |
5,440 |
1,619 |
$123K |
| 99401 |
|
3,952 |
3,529 |
$100K |
| 90686 |
|
4,395 |
4,238 |
$82K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,332 |
1,243 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,526 |
945 |
$75K |
| D1206 |
Topical application of fluoride varnish |
3,009 |
2,841 |
$60K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
4,387 |
4,176 |
$57K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,519 |
2,422 |
$53K |
| D1110 |
Prophylaxis - adult |
1,447 |
1,380 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
667 |
499 |
$42K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,272 |
1,151 |
$36K |
| 90670 |
|
1,749 |
1,660 |
$32K |
| D2140 |
|
712 |
593 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
403 |
170 |
$30K |
| 96127 |
|
10,066 |
9,360 |
$29K |
| 99173 |
|
7,222 |
6,682 |
$28K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
977 |
904 |
$23K |
| 90674 |
|
1,268 |
1,150 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,208 |
1,960 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
895 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
261 |
213 |
$20K |
| 94664 |
|
2,174 |
2,062 |
$19K |
| 92551 |
|
4,312 |
4,013 |
$17K |
| 94010 |
|
808 |
790 |
$17K |
| 90680 |
|
832 |
784 |
$15K |
| 90698 |
|
720 |
670 |
$13K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
228 |
222 |
$12K |
| 0002A |
|
299 |
289 |
$12K |
| 0001A |
|
324 |
289 |
$11K |
| 0071A |
|
218 |
209 |
$8K |
| 90651 |
|
407 |
381 |
$7K |
| G0312 |
Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes) |
650 |
618 |
$7K |
| 0072A |
|
182 |
176 |
$7K |
| 90661 |
|
281 |
273 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
463 |
436 |
$5K |
| 90633 |
|
182 |
172 |
$3K |
| 90677 |
|
200 |
175 |
$3K |
| 90744 |
|
159 |
146 |
$3K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
336 |
301 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
111 |
108 |
$2K |
| 96160 |
|
1,011 |
941 |
$2K |
| 90716 |
|
120 |
110 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
69 |
$2K |
| 90707 |
|
107 |
101 |
$2K |
| D9110 |
|
50 |
45 |
$2K |
| 90734 |
|
81 |
78 |
$1K |
| 90620 |
|
72 |
72 |
$1K |
| 83655 |
|
98 |
94 |
$1K |
| 90648 |
|
62 |
62 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
33 |
33 |
$1K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
118 |
106 |
$1K |
| 96161 |
|
381 |
327 |
$952.56 |
| 36415 |
Collection of venous blood by venipuncture |
423 |
392 |
$760.00 |
| 36416 |
|
377 |
340 |
$677.50 |
| 85027 |
|
129 |
124 |
$603.92 |
| 0003A |
|
18 |
14 |
$560.00 |
| 0124A |
|
13 |
13 |
$520.00 |
| 92567 |
|
26 |
25 |
$337.66 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$288.00 |
| 90696 |
|
15 |
14 |
$277.06 |
| 90700 |
|
12 |
12 |
$237.48 |
| 99177 |
|
27 |
27 |
$178.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
13 |
$147.00 |
| 94760 |
|
566 |
523 |
$0.00 |
| 99051 |
|
13 |
13 |
$0.00 |