| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
9,270 |
5,433 |
$340K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,670 |
8,148 |
$291K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,704 |
2,218 |
$157K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,842 |
1,544 |
$109K |
| D1351 |
Sealant - per tooth |
4,220 |
1,226 |
$91K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,190 |
785 |
$60K |
| D1120 |
Prophylaxis - child |
2,948 |
2,848 |
$58K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,555 |
991 |
$36K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,829 |
2,171 |
$28K |
| D1330 |
|
5,939 |
5,701 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
890 |
833 |
$24K |
| D0330 |
Panoramic radiographic image |
1,238 |
1,131 |
$24K |
| D1206 |
Topical application of fluoride varnish |
4,965 |
4,798 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
531 |
395 |
$21K |
| 99401 |
|
1,057 |
984 |
$20K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
252 |
242 |
$19K |
| D1110 |
Prophylaxis - adult |
713 |
698 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,613 |
1,434 |
$17K |
| 99381 |
|
226 |
188 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,454 |
1,161 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
563 |
383 |
$14K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
331 |
306 |
$14K |
| 59430 |
|
340 |
274 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,488 |
1,364 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,457 |
964 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
126 |
102 |
$8K |
| D0191 |
|
3,900 |
3,813 |
$7K |
| D0274 |
Bitewings - four radiographic images |
518 |
482 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,988 |
1,748 |
$5K |
| 90671 |
|
382 |
337 |
$5K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,203 |
1,066 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
177 |
177 |
$4K |
| 90461 |
|
1,849 |
1,129 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,062 |
1,830 |
$2K |
| 81025 |
|
1,624 |
1,288 |
$2K |
| 90686 |
|
655 |
605 |
$2K |
| 90670 |
|
866 |
663 |
$2K |
| 99349 |
|
27 |
24 |
$2K |
| 81002 |
|
3,407 |
2,082 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
54 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
2,807 |
2,297 |
$1K |
| D0190 |
|
464 |
409 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| 83655 |
|
280 |
266 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
175 |
64 |
$967.50 |
| 99406 |
|
176 |
161 |
$883.40 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
16 |
13 |
$865.10 |
| 90647 |
|
363 |
240 |
$686.60 |
| 90474 |
|
131 |
115 |
$656.00 |
| 91301 |
|
29 |
25 |
$644.23 |
| D4346 |
|
26 |
26 |
$634.56 |
| 90723 |
|
341 |
301 |
$534.00 |
| 3074F |
|
9,978 |
7,814 |
$505.28 |
| 82962 |
|
538 |
470 |
$464.88 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
98 |
85 |
$390.74 |
| D9995 |
|
21 |
17 |
$371.88 |
| 90681 |
|
480 |
422 |
$332.40 |
| D4342 |
|
36 |
26 |
$312.32 |
| 85018 |
|
512 |
476 |
$287.30 |
| D0603 |
|
3,141 |
2,972 |
$283.00 |
| 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 |
265 |
216 |
$279.40 |
| D0601 |
|
1,863 |
1,806 |
$251.00 |
| D0602 |
|
188 |
182 |
$180.32 |
| 90697 |
|
329 |
282 |
$166.59 |
| 0011A |
|
37 |
24 |
$127.05 |
| 0012A |
|
23 |
15 |
$120.00 |
| 90633 |
|
318 |
276 |
$83.72 |
| 3075F |
|
687 |
574 |
$75.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$59.60 |
| 90685 |
|
32 |
31 |
$55.00 |
| 90734 |
|
12 |
12 |
$51.00 |
| 3078F |
|
8,629 |
6,457 |
$35.22 |
| 90674 |
|
70 |
59 |
$30.00 |
| 90715 |
|
18 |
14 |
$30.00 |
| 1160F |
|
15,683 |
12,812 |
$28.44 |
| 2000F |
|
13,897 |
10,370 |
$24.83 |
| 90680 |
|
19 |
14 |
$20.00 |
| 90656 |
|
89 |
85 |
$16.28 |
| 2001F |
|
20,393 |
15,727 |
$16.10 |
| 81003 |
|
2,938 |
1,643 |
$16.01 |
| 4037F |
|
339 |
332 |
$15.80 |
| 92587 |
|
241 |
108 |
$14.83 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
165 |
74 |
$10.18 |
| 96127 |
|
1,636 |
1,493 |
$10.17 |
| 90716 |
|
25 |
24 |
$10.00 |
| D0272 |
Bitewings - two radiographic images |
38 |
28 |
$7.00 |
| D0270 |
|
253 |
229 |
$5.98 |
| 1036F |
|
1,762 |
1,477 |
$4.86 |
| 2010F |
|
7,958 |
6,340 |
$4.21 |
| 1159F |
|
15,544 |
12,713 |
$2.42 |
| 99000 |
|
338 |
168 |
$2.10 |
| 3008F |
|
11,738 |
9,387 |
$0.03 |
| 1220F |
|
5,317 |
4,635 |
$0.00 |
| 3079F |
|
2,268 |
1,713 |
$0.00 |
| 4000F |
|
3,747 |
3,369 |
$0.00 |
| 1126F |
|
4,881 |
4,004 |
$0.00 |
| 1000F |
|
9,006 |
7,374 |
$0.00 |
| D1310 |
|
3,949 |
3,809 |
$0.00 |
| 3044F |
|
1,362 |
1,092 |
$0.00 |
| 1125F |
|
676 |
602 |
$0.00 |
| 92551 |
|
523 |
347 |
$0.00 |
| 90677 |
|
63 |
61 |
$0.00 |
| 1157F |
|
426 |
156 |
$0.00 |
| 1055F |
|
566 |
427 |
$0.00 |
| 36416 |
|
407 |
318 |
$0.00 |
| D4999 |
|
269 |
268 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
24 |
24 |
$0.00 |
| 3351F |
|
114 |
101 |
$0.00 |
| 90651 |
|
13 |
12 |
$0.00 |
| 4010F |
|
59 |
35 |
$0.00 |
| 1034F |
|
27 |
26 |
$0.00 |
| 90698 |
|
102 |
94 |
$0.00 |
| 3080F |
|
38 |
25 |
$0.00 |
| 0501F |
|
14 |
14 |
$0.00 |
| 90694 |
|
15 |
15 |
$0.00 |
| 0502F |
|
370 |
205 |
$0.00 |
| 99173 |
|
952 |
620 |
$0.00 |
| 3077F |
|
138 |
111 |
$0.00 |
| 4035F |
|
46 |
45 |
$0.00 |
| 90648 |
|
116 |
101 |
$0.00 |
| 90756 |
|
13 |
12 |
$0.00 |
| D0180 |
|
18 |
18 |
$0.00 |
| 99177 |
|
26 |
25 |
$0.00 |