| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
76,918 |
58,361 |
$314K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,320 |
1,418 |
$160K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
825 |
536 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,508 |
2,092 |
$53K |
| D1110 |
Prophylaxis - adult |
1,308 |
1,073 |
$43K |
| D1120 |
Prophylaxis - child |
1,135 |
958 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,349 |
1,129 |
$19K |
| 0012A |
|
173 |
157 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
778 |
585 |
$9K |
| 0011A |
|
219 |
191 |
$8K |
| D0274 |
Bitewings - four radiographic images |
257 |
236 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
87 |
$7K |
| 0001A |
|
78 |
75 |
$5K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
325 |
212 |
$4K |
| 0002A |
|
62 |
59 |
$4K |
| 0031A |
|
113 |
90 |
$3K |
| 0071A |
|
52 |
31 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
53 |
$2K |
| 0072A |
|
40 |
23 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
657 |
500 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$1K |
| 0064A |
|
30 |
18 |
$928.00 |
| D0272 |
Bitewings - two radiographic images |
65 |
63 |
$922.97 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$740.09 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
369 |
259 |
$513.10 |
| 90686 |
|
354 |
278 |
$379.84 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
210 |
129 |
$330.04 |
| 87210 |
|
30 |
25 |
$111.55 |
| 82120 |
|
30 |
25 |
$76.48 |
| 99000 |
|
2,269 |
1,660 |
$70.88 |
| 85018 |
|
33 |
28 |
$69.23 |
| 90656 |
|
13 |
12 |
$41.06 |
| 81002 |
|
14 |
12 |
$39.00 |
| 90688 |
|
15 |
13 |
$17.51 |
| 91300 |
|
177 |
141 |
$0.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
12 |
12 |
$0.00 |
| 91301 |
|
436 |
346 |
$0.00 |
| 91303 |
|
107 |
84 |
$0.00 |
| 87800 |
|
92 |
78 |
$0.00 |
| 91307 |
|
114 |
62 |
$0.00 |
| 86701 |
|
31 |
26 |
$0.00 |
| 86592 |
|
31 |
26 |
$0.00 |
| 91306 |
|
28 |
17 |
$0.00 |