| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
50,750 |
26,258 |
$2.66M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12,434 |
7,388 |
$665K |
| 36415 |
Collection of venous blood by venipuncture |
27,150 |
9,540 |
$558K |
| D0120 |
Periodic oral evaluation - established patient |
6,664 |
3,295 |
$199K |
| D1110 |
Prophylaxis - adult |
6,484 |
2,478 |
$175K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,860 |
1,268 |
$96K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,906 |
744 |
$81K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,334 |
650 |
$79K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
960 |
534 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
2,528 |
2,018 |
$47K |
| 99215 |
Prolong outpt/office vis |
502 |
277 |
$40K |
| D1120 |
Prophylaxis - child |
1,364 |
475 |
$35K |
| 90832 |
Psychotherapy, 30 minutes with patient |
447 |
220 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
677 |
$32K |
| 90834 |
Psychotherapy, 45 minutes with patient |
373 |
235 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
914 |
600 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,217 |
1,084 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
584 |
$23K |
| 99442 |
|
305 |
163 |
$19K |
| 97124 |
|
311 |
103 |
$18K |
| 96127 |
|
3,390 |
2,777 |
$17K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
207 |
130 |
$16K |
| 99441 |
|
218 |
155 |
$16K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,084 |
1,069 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
125 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
725 |
134 |
$11K |
| 97014 |
|
152 |
92 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
137 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,189 |
1,130 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
225 |
52 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
188 |
45 |
$4K |
| 99000 |
|
4,312 |
4,142 |
$4K |
| 99443 |
|
53 |
32 |
$3K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
95 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
27 |
$2K |
| 90686 |
|
238 |
238 |
$1K |
| D1351 |
Sealant - per tooth |
43 |
14 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
228 |
221 |
$1K |
| D1206 |
Topical application of fluoride varnish |
48 |
45 |
$1K |
| 81025 |
|
99 |
95 |
$818.91 |
| 97803 |
|
12 |
12 |
$798.15 |
| 3074F |
|
5,077 |
4,642 |
$525.00 |
| 92551 |
|
160 |
160 |
$465.00 |
| 3078F |
|
4,177 |
3,840 |
$377.50 |
| 99173 |
|
143 |
142 |
$177.49 |
| 81002 |
|
122 |
101 |
$171.16 |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$168.00 |
| D9110 |
|
12 |
12 |
$167.46 |
| 90461 |
|
27 |
27 |
$123.96 |
| 90688 |
|
12 |
12 |
$75.88 |
| 3079F |
|
1,202 |
1,127 |
$57.50 |
| 82948 |
|
31 |
30 |
$49.42 |
| 1160F |
|
9,254 |
7,628 |
$30.00 |
| 1159F |
|
8,040 |
6,644 |
$25.00 |
| 90656 |
|
74 |
74 |
$20.81 |
| 1126F |
|
8,490 |
7,182 |
$20.00 |
| 1036F |
|
8,056 |
6,504 |
$0.00 |
| 3008F |
|
10,117 |
8,404 |
$0.00 |
| 1125F |
|
170 |
166 |
$0.00 |
| 1034F |
|
199 |
164 |
$0.00 |
| 3075F |
|
266 |
254 |
$0.00 |
| 3725F |
|
6,492 |
5,347 |
$0.00 |
| 3077F |
|
25 |
24 |
$0.00 |