| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
701,089 |
615,852 |
$3.69M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,112 |
2,133 |
$365K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,578 |
3,317 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,010 |
2,131 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
6,355 |
6,288 |
$192K |
| D1120 |
Prophylaxis - child |
5,720 |
5,668 |
$178K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,388 |
2,825 |
$172K |
| D1351 |
Sealant - per tooth |
3,647 |
1,330 |
$125K |
| D1110 |
Prophylaxis - adult |
2,275 |
2,252 |
$102K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
899 |
666 |
$93K |
| D1206 |
Topical application of fluoride varnish |
4,041 |
3,996 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,823 |
3,781 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,210 |
1,193 |
$58K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,690 |
1,493 |
$54K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,180 |
995 |
$53K |
| D0240 |
|
2,785 |
1,535 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,446 |
2,425 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,322 |
1,308 |
$50K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,344 |
2,033 |
$39K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,897 |
2,328 |
$34K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
268 |
208 |
$31K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,061 |
890 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
509 |
500 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
160 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
813 |
793 |
$14K |
| D4355 |
|
185 |
184 |
$13K |
| 81025 |
|
1,502 |
1,202 |
$11K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
63 |
52 |
$10K |
| 36415 |
Collection of venous blood by venipuncture |
5,083 |
3,495 |
$10K |
| 81002 |
|
4,898 |
2,878 |
$9K |
| 0001A |
|
230 |
176 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
100 |
86 |
$6K |
| 96127 |
|
1,384 |
1,156 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
382 |
307 |
$5K |
| 87210 |
|
1,410 |
1,113 |
$5K |
| 83986 |
|
1,405 |
1,111 |
$4K |
| 82120 |
|
1,355 |
1,070 |
$4K |
| 0002A |
|
56 |
50 |
$3K |
| 92552 |
|
452 |
348 |
$2K |
| 90715 |
|
355 |
285 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,419 |
1,984 |
$1K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,390 |
1,956 |
$1K |
| 90688 |
|
456 |
361 |
$1K |
| 80061 |
Lipid panel |
108 |
69 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
18 |
14 |
$1K |
| 85018 |
|
185 |
155 |
$582.93 |
| 0011A |
|
29 |
24 |
$552.46 |
| 90651 |
|
134 |
116 |
$552.12 |
| 90716 |
|
13 |
13 |
$543.72 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
79 |
58 |
$499.75 |
| 99173 |
|
532 |
409 |
$428.75 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
13 |
$427.44 |
| 86803 |
|
75 |
57 |
$186.76 |
| 86703 |
|
1,258 |
1,005 |
$175.84 |
| 87088 |
|
689 |
562 |
$134.00 |
| 90734 |
|
185 |
136 |
$115.00 |
| 82947 |
|
17 |
12 |
$64.72 |
| 96160 |
|
30 |
25 |
$59.84 |
| 86787 |
|
497 |
393 |
$24.08 |
| 86592 |
|
315 |
264 |
$17.38 |
| 82950 |
|
230 |
189 |
$0.00 |
| 99000 |
|
6,217 |
4,307 |
$0.00 |
| 88142 |
|
179 |
136 |
$0.00 |
| 80055 |
|
518 |
417 |
$0.00 |
| 91301 |
|
32 |
27 |
$0.00 |
| 90619 |
|
327 |
272 |
$0.00 |
| 36416 |
|
97 |
79 |
$0.00 |
| 0500F |
|
79 |
72 |
$0.00 |
| 82105 |
|
17 |
13 |
$0.00 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
17 |
13 |
$0.00 |
| 83020 |
|
110 |
96 |
$0.00 |
| 91300 |
|
356 |
244 |
$0.00 |
| 90633 |
|
81 |
74 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |