| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,724 |
4,630 |
$238K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,706 |
4,432 |
$220K |
| D1120 |
Prophylaxis - child |
3,224 |
3,187 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,864 |
3,805 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,520 |
4,452 |
$87K |
| 99401 |
|
2,545 |
1,978 |
$62K |
| 99402 |
|
1,195 |
938 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,906 |
2,866 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
582 |
368 |
$35K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,506 |
2,017 |
$33K |
| D1110 |
Prophylaxis - adult |
787 |
786 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
805 |
698 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
213 |
$22K |
| 81025 |
|
4,672 |
3,569 |
$17K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
237 |
209 |
$17K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,299 |
1,000 |
$16K |
| 99406 |
|
2,473 |
1,426 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
631 |
620 |
$16K |
| D1351 |
Sealant - per tooth |
628 |
179 |
$13K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
196 |
147 |
$13K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
341 |
280 |
$12K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
228 |
172 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
440 |
346 |
$10K |
| 90716 |
|
1,021 |
822 |
$10K |
| 99177 |
|
1,257 |
840 |
$9K |
| 90651 |
|
549 |
388 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
170 |
121 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
112 |
55 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,011 |
746 |
$6K |
| 96127 |
|
1,488 |
951 |
$6K |
| 94250 |
|
370 |
189 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
4,621 |
3,651 |
$5K |
| D1206 |
Topical application of fluoride varnish |
277 |
276 |
$5K |
| D1354 |
|
576 |
101 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
109 |
65 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
737 |
535 |
$5K |
| 92558 |
|
818 |
538 |
$4K |
| 90734 |
|
493 |
357 |
$4K |
| 88738 |
|
1,287 |
878 |
$4K |
| 90707 |
|
928 |
762 |
$3K |
| 90715 |
|
402 |
301 |
$3K |
| 91322 |
|
136 |
101 |
$3K |
| 90746 |
|
57 |
38 |
$3K |
| 87210 |
|
1,335 |
1,011 |
$3K |
| 90686 |
|
833 |
692 |
$3K |
| 36416 |
|
1,536 |
1,149 |
$3K |
| 99384 |
|
26 |
13 |
$2K |
| 92587 |
|
65 |
50 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
29 |
27 |
$2K |
| 81002 |
|
1,015 |
674 |
$1K |
| 90670 |
|
770 |
603 |
$1K |
| 99403 |
|
21 |
12 |
$1K |
| 90480 |
|
136 |
104 |
$1K |
| 90620 |
|
30 |
27 |
$1K |
| 99442 |
|
37 |
21 |
$820.53 |
| 90632 |
|
40 |
28 |
$816.69 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$610.00 |
| 85018 |
|
424 |
323 |
$604.40 |
| 90677 |
|
56 |
38 |
$568.00 |
| 90633 |
|
923 |
736 |
$530.54 |
| 99441 |
|
31 |
15 |
$447.38 |
| T2028 |
Specialized supply, not otherwise specified, waiver |
41 |
12 |
$432.25 |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
33 |
$358.68 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$339.36 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
46 |
40 |
$338.50 |
| 90688 |
|
207 |
166 |
$270.36 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$249.56 |
| 92551 |
|
36 |
28 |
$221.75 |
| 99071 |
|
194 |
98 |
$160.00 |
| 90700 |
|
170 |
125 |
$90.25 |
| 90723 |
|
216 |
164 |
$84.12 |
| 96160 |
|
41 |
18 |
$58.40 |
| 90647 |
|
355 |
277 |
$54.00 |
| 90713 |
|
54 |
40 |
$44.00 |
| 90744 |
|
15 |
13 |
$25.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,574 |
1,335 |
$0.00 |
| 90682 |
|
176 |
106 |
$0.00 |
| 90681 |
|
14 |
12 |
$0.00 |
| 90671 |
|
17 |
16 |
$0.00 |
| 90696 |
|
85 |
75 |
$0.00 |
| 90698 |
|
90 |
68 |
$0.00 |
| 90697 |
|
13 |
13 |
$0.00 |