| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,536 |
10,751 |
$1.79M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,780 |
7,950 |
$1.62M |
| D1110 |
Prophylaxis - adult |
7,692 |
7,100 |
$1.44M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,035 |
6,331 |
$1.23M |
| D1206 |
Topical application of fluoride varnish |
19,847 |
18,545 |
$735K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,516 |
5,193 |
$684K |
| D0140 |
Limited oral evaluation - problem focused |
5,227 |
4,681 |
$656K |
| D1351 |
Sealant - per tooth |
10,147 |
2,795 |
$524K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,351 |
2,867 |
$475K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,494 |
2,321 |
$450K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,478 |
1,770 |
$277K |
| D0330 |
Panoramic radiographic image |
1,675 |
1,528 |
$267K |
| 90834 |
Psychotherapy, 45 minutes with patient |
1,258 |
963 |
$235K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,343 |
800 |
$213K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,527 |
1,073 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
13,866 |
12,802 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
10,935 |
9,722 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
389 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
785 |
763 |
$78K |
| D0274 |
Bitewings - four radiographic images |
6,009 |
5,535 |
$77K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
229 |
227 |
$52K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
208 |
203 |
$37K |
| 90832 |
Psychotherapy, 30 minutes with patient |
194 |
168 |
$36K |
| D2140 |
|
285 |
216 |
$27K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
139 |
129 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
88 |
88 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
61 |
$15K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
30 |
29 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,069 |
1,025 |
$6K |
| D0272 |
Bitewings - two radiographic images |
5,211 |
4,822 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
107 |
89 |
$4K |
| D1354 |
|
572 |
185 |
$3K |
| D2331 |
|
37 |
28 |
$2K |
| D2330 |
|
41 |
31 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
454 |
443 |
$2K |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
359 |
295 |
$1K |
| 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 |
2,054 |
1,740 |
$1K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
177 |
172 |
$915.81 |
| 0012A |
|
81 |
71 |
$856.45 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
226 |
218 |
$854.78 |
| 0011A |
|
90 |
80 |
$844.50 |
| D2332 |
|
19 |
12 |
$741.04 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
405 |
394 |
$607.61 |
| 0002A |
|
22 |
22 |
$480.00 |
| 90651 |
|
76 |
73 |
$409.74 |
| 96127 |
|
65 |
62 |
$307.06 |
| 90686 |
|
481 |
463 |
$304.36 |
| 80053 |
Comprehensive metabolic panel |
96 |
92 |
$288.90 |
| 0001A |
|
13 |
13 |
$280.00 |
| 0013A |
|
13 |
13 |
$202.59 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
13 |
13 |
$191.60 |
| D4346 |
|
15 |
14 |
$188.78 |
| 81025 |
|
224 |
213 |
$176.46 |
| 84443 |
Thyroid stimulating hormone (TSH) |
75 |
70 |
$94.50 |
| 90656 |
|
36 |
35 |
$84.24 |
| 36415 |
Collection of venous blood by venipuncture |
3,508 |
3,306 |
$51.75 |
| 80061 |
Lipid panel |
18 |
15 |
$45.36 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
55 |
53 |
$38.75 |
| 80305 |
|
36 |
24 |
$22.98 |
| 90674 |
|
19 |
18 |
$22.94 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
26 |
25 |
$19.50 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
26 |
25 |
$19.50 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
258 |
218 |
$14.89 |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,351 |
4,319 |
$11.45 |
| 81003 |
|
195 |
181 |
$7.91 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
191 |
181 |
$7.50 |
| 87210 |
|
13 |
13 |
$5.02 |
| 91300 |
|
60 |
50 |
$0.00 |
| 99001 |
|
189 |
185 |
$0.00 |
| 90734 |
|
56 |
53 |
$0.00 |
| D9110 |
|
66 |
51 |
$0.00 |
| 80365 |
|
90 |
62 |
$0.00 |
| 90461 |
|
110 |
109 |
$0.00 |
| 80361 |
|
90 |
62 |
$0.00 |
| 80346 |
|
90 |
62 |
$0.00 |
| 90687 |
|
13 |
13 |
$0.00 |
| D4341 |
|
42 |
31 |
$0.00 |
| D0240 |
|
1,704 |
731 |
$0.00 |
| 81015 |
|
172 |
160 |
$0.00 |
| 91301 |
|
195 |
171 |
$0.00 |
| 99000 |
|
1,243 |
1,152 |
$0.00 |
| 80349 |
|
90 |
62 |
$0.00 |
| D0601 |
|
96 |
90 |
$0.00 |
| 81001 |
|
70 |
63 |
$0.00 |
| 80353 |
|
90 |
62 |
$0.00 |
| D0603 |
|
63 |
62 |
$0.00 |
| D0602 |
|
37 |
37 |
$0.00 |