| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,971 |
3,938 |
$135K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
878 |
725 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
986 |
733 |
$50K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,003 |
761 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,211 |
841 |
$42K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,226 |
989 |
$42K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
552 |
506 |
$37K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
694 |
527 |
$36K |
| D0330 |
Panoramic radiographic image |
923 |
887 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,315 |
1,179 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,277 |
1,003 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
457 |
$17K |
| D1110 |
Prophylaxis - adult |
622 |
608 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,963 |
1,320 |
$17K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,850 |
1,394 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
416 |
345 |
$8K |
| D1120 |
Prophylaxis - child |
536 |
518 |
$8K |
| D1351 |
Sealant - per tooth |
786 |
239 |
$8K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
255 |
184 |
$7K |
| D1330 |
|
1,529 |
1,469 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
569 |
532 |
$4K |
| D0274 |
Bitewings - four radiographic images |
613 |
611 |
$4K |
| 90670 |
|
263 |
231 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,206 |
1,056 |
$3K |
| 99385 |
|
87 |
56 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
98 |
70 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
582 |
496 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
37 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
1,113 |
1,067 |
$2K |
| 90461 |
|
840 |
449 |
$2K |
| 90671 |
|
24 |
24 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
23 |
18 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
37 |
$2K |
| H1000 |
Prenatal care, at-risk assessment |
88 |
53 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,802 |
1,626 |
$1K |
| 99401 |
|
147 |
125 |
$1K |
| 90686 |
|
433 |
408 |
$1K |
| 99383 |
|
14 |
14 |
$939.86 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$783.45 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
15 |
14 |
$703.17 |
| D0272 |
Bitewings - two radiographic images |
367 |
366 |
$595.32 |
| 90651 |
|
206 |
202 |
$535.20 |
| 81025 |
|
481 |
345 |
$519.00 |
| 99386 |
|
14 |
12 |
$464.29 |
| 87428 |
|
76 |
66 |
$418.44 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
15 |
15 |
$390.80 |
| D0190 |
|
64 |
61 |
$378.68 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
70 |
65 |
$339.28 |
| 83655 |
|
90 |
82 |
$327.54 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
53 |
50 |
$318.16 |
| D0191 |
|
126 |
126 |
$251.75 |
| D0602 |
|
676 |
641 |
$202.50 |
| 3074F |
|
4,642 |
3,959 |
$200.00 |
| 36415 |
Collection of venous blood by venipuncture |
394 |
292 |
$191.96 |
| 90710 |
|
14 |
12 |
$161.19 |
| 90723 |
|
61 |
56 |
$159.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
26 |
24 |
$156.78 |
| 85018 |
|
295 |
269 |
$156.27 |
| D0603 |
|
1,312 |
1,194 |
$129.88 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
44 |
27 |
$112.53 |
| D1208 |
Topical application of fluoride, excluding varnish |
21 |
21 |
$96.62 |
| 90647 |
|
50 |
46 |
$88.00 |
| 3044F |
|
231 |
199 |
$60.00 |
| 92551 |
|
524 |
500 |
$47.32 |
| D3120 |
|
64 |
55 |
$32.84 |
| 3075F |
|
141 |
110 |
$25.00 |
| 90681 |
|
13 |
13 |
$20.00 |
| 92587 |
|
256 |
72 |
$16.38 |
| 90734 |
|
52 |
50 |
$15.60 |
| D0601 |
|
75 |
75 |
$15.00 |
| 99173 |
|
1,186 |
870 |
$12.20 |
| 2010F |
|
3,308 |
2,952 |
$12.00 |
| 82962 |
|
15 |
14 |
$10.57 |
| 4037F |
|
94 |
92 |
$10.00 |
| 1159F |
|
7,507 |
6,411 |
$10.00 |
| 90633 |
|
92 |
67 |
$10.00 |
| 3078F |
|
4,101 |
3,442 |
$9.60 |
| 81002 |
|
18 |
13 |
$8.82 |
| 81003 |
|
431 |
259 |
$7.28 |
| 1036F |
|
179 |
167 |
$5.05 |
| 1160F |
|
7,467 |
6,398 |
$1.80 |
| 3008F |
|
7,387 |
5,988 |
$0.02 |
| 2000F |
|
6,114 |
5,062 |
$0.00 |
| 1220F |
|
2,975 |
2,530 |
$0.00 |
| D1310 |
|
668 |
643 |
$0.00 |
| 3351F |
|
97 |
94 |
$0.00 |
| 2001F |
|
8,888 |
7,364 |
$0.00 |
| 4000F |
|
2,351 |
2,061 |
$0.00 |
| 3079F |
|
812 |
654 |
$0.00 |
| 1055F |
|
501 |
476 |
$0.00 |
| 96127 |
|
81 |
78 |
$0.00 |
| 1000F |
|
3,854 |
3,233 |
$0.00 |
| 1126F |
|
1,102 |
948 |
$0.00 |
| D4999 |
|
168 |
167 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
13 |
$0.00 |
| 1125F |
|
33 |
32 |
$0.00 |
| 90619 |
|
30 |
30 |
$0.00 |
| 99000 |
|
43 |
37 |
$0.00 |
| 1157F |
|
180 |
52 |
$0.00 |
| 36416 |
|
14 |
13 |
$0.00 |
| 3077F |
|
17 |
12 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |
| 3210F |
|
130 |
109 |
$0.00 |
| 99188 |
|
18 |
17 |
$0.00 |
| 3725F |
|
12 |
12 |
$0.00 |
| 4035F |
|
13 |
13 |
$0.00 |
| 4062F |
|
14 |
14 |
$0.00 |
| 0502F |
|
18 |
13 |
$0.00 |