| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
769,811 |
760,568 |
$4.01M |
| 99215 |
Prolong outpt/office vis |
2,674 |
2,473 |
$483K |
| 59426 |
|
595 |
483 |
$372K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
5,996 |
5,573 |
$271K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
7,137 |
6,037 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,969 |
5,756 |
$166K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,206 |
1,753 |
$164K |
| D1120 |
Prophylaxis - child |
4,465 |
4,324 |
$130K |
| D1351 |
Sealant - per tooth |
7,433 |
2,079 |
$129K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
6,950 |
5,528 |
$122K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
6,953 |
5,516 |
$121K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,709 |
3,552 |
$107K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
9,782 |
7,408 |
$102K |
| D1206 |
Topical application of fluoride varnish |
5,014 |
4,783 |
$86K |
| D1110 |
Prophylaxis - adult |
2,119 |
2,015 |
$82K |
| 99502 |
|
1,354 |
1,272 |
$73K |
| 90715 |
|
3,424 |
2,553 |
$69K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
743 |
573 |
$57K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,014 |
2,709 |
$49K |
| 86592 |
|
10,263 |
8,917 |
$48K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
250 |
247 |
$46K |
| 99501 |
|
953 |
901 |
$45K |
| 81025 |
|
6,024 |
5,070 |
$44K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
4,369 |
3,905 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,223 |
2,174 |
$43K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
420 |
336 |
$36K |
| 36415 |
Collection of venous blood by venipuncture |
14,852 |
11,771 |
$36K |
| 59430 |
|
418 |
334 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
340 |
$32K |
| 99205 |
Prolong outpt/office vis |
136 |
129 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,941 |
1,914 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
275 |
236 |
$29K |
| D0274 |
Bitewings - four radiographic images |
821 |
794 |
$28K |
| 90686 |
|
4,003 |
2,863 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
582 |
565 |
$25K |
| 90632 |
|
579 |
503 |
$25K |
| 99442 |
|
268 |
240 |
$21K |
| 82950 |
|
3,376 |
3,067 |
$19K |
| 90716 |
|
1,039 |
798 |
$18K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
179 |
130 |
$17K |
| 90707 |
|
387 |
304 |
$16K |
| 99441 |
|
273 |
249 |
$15K |
| 90713 |
|
1,234 |
1,027 |
$15K |
| 59425 |
|
36 |
36 |
$14K |
| 90746 |
|
345 |
237 |
$12K |
| 91320 |
|
157 |
151 |
$11K |
| 90480 |
|
325 |
309 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
202 |
$10K |
| 85027 |
|
1,219 |
1,129 |
$9K |
| 91322 |
|
98 |
92 |
$9K |
| 80053 |
Comprehensive metabolic panel |
891 |
782 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
31 |
$7K |
| 82951 |
|
431 |
372 |
$6K |
| D1354 |
|
1,305 |
340 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
71 |
58 |
$6K |
| T1002 |
Rn services, up to 15 minutes |
266 |
140 |
$5K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
323 |
265 |
$5K |
| 87210 |
|
1,455 |
1,070 |
$5K |
| 90651 |
|
326 |
261 |
$4K |
| 97802 |
|
65 |
53 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
37 |
$4K |
| D0330 |
Panoramic radiographic image |
73 |
68 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
87 |
86 |
$2K |
| 99443 |
|
17 |
16 |
$2K |
| 90734 |
|
378 |
243 |
$2K |
| 90619 |
|
149 |
136 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
57 |
$903.52 |
| 82952 |
|
182 |
151 |
$812.06 |
| 81002 |
|
1,756 |
1,527 |
$788.02 |
| 90714 |
|
50 |
39 |
$317.80 |
| 91321 |
|
54 |
54 |
$256.00 |
| 82947 |
|
36 |
25 |
$199.30 |
| 86803 |
|
554 |
544 |
$190.03 |
| 90633 |
|
1,351 |
1,035 |
$160.15 |
| 86580 |
|
17 |
13 |
$72.67 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
4,344 |
3,938 |
$10.07 |
| 86901 |
|
2,585 |
2,438 |
$7.58 |
| 83020 |
|
2,439 |
2,302 |
$0.00 |
| 86787 |
|
2,622 |
2,468 |
$0.00 |
| 99071 |
|
2,642 |
2,509 |
$0.00 |
| 83655 |
|
744 |
705 |
$0.00 |
| 87341 |
|
2,669 |
2,513 |
$0.00 |
| T1001 |
Nursing assessment / evaluation |
3,015 |
2,413 |
$0.00 |
| 99401 |
|
3,939 |
3,573 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
740 |
619 |
$0.00 |
| 90649 |
|
237 |
169 |
$0.00 |
| 99499 |
|
330 |
261 |
$0.00 |
| 82570 |
|
13 |
13 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 86705 |
|
47 |
38 |
$0.00 |
| 90710 |
|
28 |
12 |
$0.00 |
| 84156 |
|
14 |
14 |
$0.00 |
| 86762 |
|
2,599 |
2,462 |
$0.00 |
| 1000F |
|
5,848 |
4,968 |
$0.00 |
| D1353 |
|
545 |
160 |
$0.00 |
| 88142 |
|
648 |
592 |
$0.00 |
| D1330 |
|
348 |
343 |
$0.00 |
| 0525F |
|
148 |
129 |
$0.00 |
| 87088 |
|
2,700 |
2,534 |
$0.00 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
116 |
106 |
$0.00 |
| 1034F |
|
456 |
382 |
$0.00 |
| 86481 |
|
158 |
138 |
$0.00 |
| 0526F |
|
534 |
436 |
$0.00 |
| 90743 |
|
348 |
273 |
$0.00 |
| 86850 |
|
2,594 |
2,444 |
$0.00 |
| 4450F |
|
632 |
527 |
$0.00 |
| 90723 |
|
33 |
22 |
$0.00 |
| 88299 |
|
89 |
86 |
$0.00 |
| 90744 |
|
53 |
49 |
$0.00 |
| 90656 |
|
511 |
489 |
$0.00 |
| 99402 |
|
40 |
37 |
$0.00 |
| 86704 |
|
40 |
38 |
$0.00 |
| 90688 |
|
97 |
63 |
$0.00 |