| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,056 |
4,285 |
$305K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,666 |
1,381 |
$145K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,457 |
2,135 |
$107K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
910 |
754 |
$85K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
714 |
552 |
$61K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,142 |
3,170 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
779 |
741 |
$27K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
229 |
203 |
$25K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,812 |
1,151 |
$12K |
| D0330 |
Panoramic radiographic image |
225 |
220 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
121 |
112 |
$5K |
| D1110 |
Prophylaxis - adult |
262 |
254 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
57 |
57 |
$3K |
| D1120 |
Prophylaxis - child |
548 |
526 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
642 |
614 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
26 |
24 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
646 |
410 |
$1K |
| D0274 |
Bitewings - four radiographic images |
242 |
226 |
$872.78 |
| D1330 |
|
996 |
936 |
$865.26 |
| 90686 |
|
1,306 |
1,222 |
$779.56 |
| 99442 |
|
45 |
42 |
$726.60 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
27 |
$692.30 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
151 |
112 |
$678.96 |
| D0220 |
Intraoral - periapical first radiographic image |
437 |
409 |
$657.80 |
| 90461 |
|
13 |
12 |
$456.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$373.14 |
| 90723 |
|
58 |
55 |
$290.00 |
| 99441 |
|
29 |
26 |
$179.23 |
| 90633 |
|
231 |
224 |
$172.00 |
| D0272 |
Bitewings - two radiographic images |
226 |
224 |
$113.02 |
| 90670 |
|
155 |
148 |
$60.01 |
| 90734 |
|
32 |
29 |
$30.00 |
| 90651 |
|
42 |
34 |
$20.00 |
| G0008 |
Administration of influenza virus vaccine |
15 |
13 |
$10.00 |
| 90648 |
|
112 |
102 |
$0.00 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
27 |
25 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
2,235 |
1,207 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
302 |
295 |
$0.00 |
| 90620 |
|
82 |
71 |
$0.00 |
| 90656 |
|
58 |
58 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |