| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,629 |
9,714 |
$1.24M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,841 |
3,646 |
$433K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,910 |
3,685 |
$392K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,017 |
808 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
671 |
670 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,333 |
889 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,376 |
1,372 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,029 |
1,026 |
$48K |
| 99201 |
|
445 |
387 |
$44K |
| D1351 |
Sealant - per tooth |
3,561 |
1,016 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
805 |
712 |
$41K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
315 |
296 |
$33K |
| D1120 |
Prophylaxis - child |
1,862 |
1,856 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
232 |
199 |
$24K |
| 90473 |
|
5,654 |
5,642 |
$23K |
| D1206 |
Topical application of fluoride varnish |
3,204 |
3,196 |
$23K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
256 |
227 |
$21K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
880 |
859 |
$21K |
| D1110 |
Prophylaxis - adult |
612 |
612 |
$16K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,363 |
3,250 |
$14K |
| D0190 |
|
721 |
720 |
$13K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,925 |
1,880 |
$12K |
| D0330 |
Panoramic radiographic image |
277 |
276 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
152 |
$10K |
| D1354 |
|
1,515 |
353 |
$10K |
| 90672 |
|
3,822 |
3,811 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
171 |
$5K |
| D1330 |
|
3,252 |
3,244 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
224 |
224 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
27 |
27 |
$4K |
| D0272 |
Bitewings - two radiographic images |
735 |
733 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
21 |
14 |
$3K |
| 81025 |
|
506 |
493 |
$3K |
| 90686 |
|
654 |
635 |
$3K |
| D0274 |
Bitewings - four radiographic images |
227 |
227 |
$2K |
| 99403 |
|
13 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
44 |
$1K |
| 90715 |
|
303 |
296 |
$947.59 |
| D1999 |
|
16 |
16 |
$940.00 |
| 90651 |
|
348 |
342 |
$486.61 |
| 90710 |
|
257 |
249 |
$324.50 |
| 90670 |
|
98 |
97 |
$275.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$265.22 |
| 90633 |
|
172 |
169 |
$258.50 |
| D3120 |
|
17 |
16 |
$179.88 |
| 90696 |
|
70 |
69 |
$164.50 |
| 99442 |
|
19 |
13 |
$158.85 |
| 90620 |
|
25 |
24 |
$148.50 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
113 |
71 |
$109.04 |
| 87210 |
|
29 |
29 |
$80.91 |
| 87220 |
|
30 |
30 |
$77.70 |
| 90734 |
|
106 |
104 |
$77.00 |
| 90474 |
|
13 |
13 |
$49.00 |
| 90647 |
|
27 |
26 |
$38.50 |
| 1126F |
|
92 |
54 |
$21.84 |
| 90660 |
|
690 |
690 |
$0.00 |
| 90619 |
|
64 |
64 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
341 |
261 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
21 |
15 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
26 |
26 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
17 |
15 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
20 |
14 |
$0.00 |
| D9986 |
|
14 |
14 |
$0.00 |