| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,068 |
4,525 |
$2.18M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,743 |
2,507 |
$1.07M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,273 |
1,200 |
$585K |
| D0140 |
Limited oral evaluation - problem focused |
1,242 |
1,178 |
$460K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
649 |
536 |
$313K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
998 |
$292K |
| D1206 |
Topical application of fluoride varnish |
1,784 |
1,741 |
$272K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,020 |
1,001 |
$230K |
| W0037 |
|
4,570 |
4,570 |
$205K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
267 |
265 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
1,671 |
1,606 |
$121K |
| D1351 |
Sealant - per tooth |
2,515 |
686 |
$86K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,622 |
1,504 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
224 |
212 |
$65K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
224 |
201 |
$62K |
| 81003 |
|
1,638 |
1,401 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
806 |
505 |
$43K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,719 |
1,630 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
128 |
115 |
$32K |
| 0012A |
|
81 |
80 |
$32K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
52 |
52 |
$32K |
| D0272 |
Bitewings - two radiographic images |
294 |
284 |
$31K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
51 |
50 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
232 |
$29K |
| 99215 |
Prolong outpt/office vis |
76 |
75 |
$28K |
| 0071A |
|
104 |
104 |
$26K |
| 80061 |
Lipid panel |
537 |
515 |
$24K |
| 81025 |
|
149 |
144 |
$23K |
| 0072A |
|
44 |
44 |
$23K |
| 0001A |
|
67 |
56 |
$21K |
| D1110 |
Prophylaxis - adult |
118 |
109 |
$21K |
| 80053 |
Comprehensive metabolic panel |
1,036 |
965 |
$17K |
| 0011A |
|
76 |
75 |
$17K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
28 |
28 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
68 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,995 |
747 |
$12K |
| 0002A |
|
26 |
26 |
$10K |
| 92015 |
Determination of refractive state |
518 |
517 |
$8K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
985 |
941 |
$8K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
24 |
13 |
$5K |
| 84443 |
Thyroid stimulating hormone (TSH) |
550 |
527 |
$4K |
| 0134A |
|
89 |
81 |
$4K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$3K |
| 87400 |
|
565 |
543 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
612 |
587 |
$2K |
| 0124A |
|
12 |
12 |
$2K |
| D0270 |
|
85 |
84 |
$1K |
| D1354 |
|
33 |
12 |
$854.00 |
| 87807 |
|
115 |
109 |
$640.00 |
| 90734 |
|
56 |
56 |
$640.00 |
| 91300 |
|
80 |
70 |
$519.00 |
| 71046 |
Radiologic examination, chest; 2 views |
14 |
13 |
$25.02 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
135 |
134 |
$2.16 |
| 90686 |
|
335 |
327 |
$0.00 |
| 96127 |
|
17 |
17 |
$0.00 |
| 90674 |
|
60 |
60 |
$0.00 |
| 87081 |
|
194 |
187 |
$0.00 |
| 90651 |
|
37 |
36 |
$0.00 |
| 91307 |
|
39 |
39 |
$0.00 |
| 0064A |
|
14 |
14 |
$0.00 |
| 91301 |
|
46 |
45 |
$0.00 |
| 90656 |
|
18 |
18 |
$0.00 |
| 90696 |
|
34 |
34 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
64 |
56 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
345 |
345 |
$0.00 |
| 90715 |
|
34 |
34 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$0.00 |
| 90710 |
|
38 |
38 |
$0.00 |
| 0353U |
|
15 |
15 |
$0.00 |