| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,447 |
1,347 |
$145K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,027 |
1,790 |
$138K |
| 99188 |
|
1,057 |
942 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
37 |
$15K |
| 99384 |
|
195 |
177 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
231 |
204 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
66 |
58 |
$5K |
| 99383 |
|
172 |
162 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
167 |
160 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
55 |
$4K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
149 |
138 |
$3K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$3K |
| 85013 |
|
407 |
353 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
18 |
18 |
$2K |
| 99382 |
|
62 |
58 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$1K |
| G0312 |
Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes) |
30 |
29 |
$761.40 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
14 |
$679.33 |
| 85018 |
|
315 |
271 |
$573.02 |
| 83655 |
|
60 |
54 |
$565.56 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
16 |
16 |
$357.48 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
12 |
12 |
$321.08 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$290.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
31 |
25 |
$211.36 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$158.64 |
| 81025 |
|
12 |
12 |
$68.80 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$0.00 |