| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,575 |
2,144 |
$58K |
| D1330 |
|
1,526 |
1,516 |
$31K |
| D1110 |
Prophylaxis - adult |
698 |
694 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
955 |
796 |
$30K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,362 |
1,211 |
$28K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
437 |
396 |
$26K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
375 |
362 |
$26K |
| D0330 |
Panoramic radiographic image |
454 |
453 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
469 |
421 |
$17K |
| H1000 |
Prenatal care, at-risk assessment |
426 |
270 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
194 |
185 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,128 |
1,101 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
814 |
803 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
540 |
537 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,126 |
1,067 |
$7K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
500 |
470 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
58 |
58 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
1,636 |
1,508 |
$4K |
| D1206 |
Topical application of fluoride varnish |
1,185 |
1,176 |
$4K |
| D0274 |
Bitewings - four radiographic images |
734 |
731 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
507 |
477 |
$3K |
| D1120 |
Prophylaxis - child |
643 |
640 |
$3K |
| 99384 |
|
30 |
28 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,375 |
1,334 |
$1K |
| 0013A |
|
80 |
50 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
16 |
13 |
$983.55 |
| 93784 |
|
3,909 |
3,481 |
$982.14 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
129 |
117 |
$616.27 |
| 0001A |
|
17 |
16 |
$454.11 |
| 82947 |
|
232 |
213 |
$436.85 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
301 |
220 |
$399.53 |
| D0190 |
|
78 |
78 |
$374.40 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
41 |
34 |
$330.26 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$325.00 |
| 81000 |
|
318 |
273 |
$320.44 |
| D0272 |
Bitewings - two radiographic images |
267 |
266 |
$261.63 |
| 99383 |
|
15 |
13 |
$216.45 |
| 90670 |
|
302 |
292 |
$180.05 |
| 90686 |
|
465 |
427 |
$157.01 |
| D0230 |
Intraoral - periapical each additional radiographic image |
445 |
247 |
$109.17 |
| 81025 |
|
16 |
16 |
$78.90 |
| 1126F |
|
1,052 |
949 |
$60.95 |
| 90715 |
|
33 |
27 |
$41.39 |
| 1160F |
|
1,843 |
1,629 |
$0.11 |
| 1159F |
|
1,820 |
1,607 |
$0.09 |
| 3078F |
|
3,069 |
2,634 |
$0.06 |
| 3079F |
|
942 |
790 |
$0.04 |
| 1125F |
|
74 |
67 |
$0.04 |
| 3074F |
|
3,330 |
3,031 |
$0.04 |
| 1033F |
|
1,659 |
1,405 |
$0.02 |
| 3075F |
|
288 |
275 |
$0.02 |
| 1158F |
|
267 |
245 |
$0.01 |
| 91300 |
|
88 |
76 |
$0.01 |
| 4004F |
|
203 |
186 |
$0.00 |
| 3725F |
|
1,583 |
1,436 |
$0.00 |
| 99173 |
|
759 |
694 |
$0.00 |
| 90621 |
|
56 |
56 |
$0.00 |
| 3077F |
|
561 |
443 |
$0.00 |
| 90461 |
|
356 |
324 |
$0.00 |
| 90633 |
|
107 |
105 |
$0.00 |
| 90710 |
|
95 |
84 |
$0.00 |
| 90734 |
|
15 |
15 |
$0.00 |
| 0521F |
|
17 |
14 |
$0.00 |
| 1034F |
|
549 |
426 |
$0.00 |
| 3080F |
|
414 |
332 |
$0.00 |
| 3008F |
|
4,307 |
3,619 |
$0.00 |
| 92551 |
|
715 |
650 |
$0.00 |
| 1036F |
|
519 |
421 |
$0.00 |
| 90698 |
|
184 |
181 |
$0.00 |
| 90651 |
|
95 |
94 |
$0.00 |
| 4000F |
|
14 |
12 |
$0.00 |
| 1170F |
|
30 |
30 |
$0.00 |
| 1031F |
|
35 |
25 |
$0.00 |
| 90744 |
|
29 |
26 |
$0.00 |
| 91301 |
|
16 |
13 |
$0.00 |
| D0171 |
|
17 |
17 |
$0.00 |