| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,951 |
12,764 |
$2.71M |
| D1206 |
Topical application of fluoride varnish |
9,536 |
9,209 |
$844K |
| D1110 |
Prophylaxis - adult |
4,791 |
4,576 |
$671K |
| D1120 |
Prophylaxis - child |
4,773 |
4,592 |
$551K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,588 |
2,310 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
4,950 |
4,774 |
$308K |
| D0140 |
Limited oral evaluation - problem focused |
1,499 |
1,367 |
$238K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,154 |
2,044 |
$225K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,288 |
1,189 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,695 |
1,119 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,454 |
997 |
$137K |
| D0274 |
Bitewings - four radiographic images |
2,976 |
2,859 |
$98K |
| 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 |
3,654 |
2,906 |
$84K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,677 |
3,525 |
$66K |
| D1351 |
Sealant - per tooth |
2,430 |
752 |
$62K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,824 |
1,777 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,438 |
1,393 |
$54K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
179 |
173 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,310 |
1,214 |
$37K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
126 |
124 |
$25K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
79 |
77 |
$22K |
| D0330 |
Panoramic radiographic image |
1,736 |
1,634 |
$20K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
15 |
15 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
54 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
130 |
$4K |
| Q3014 |
Telehealth originating site facility fee |
256 |
224 |
$3K |
| 99173 |
|
281 |
276 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
13 |
$2K |
| 0002A |
|
68 |
67 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
15 |
$2K |
| 0001A |
|
60 |
59 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| 99384 |
|
12 |
12 |
$2K |
| D2330 |
|
17 |
13 |
$1K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
275 |
266 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,379 |
1,281 |
$896.09 |
| 90686 |
|
204 |
199 |
$718.44 |
| 90715 |
|
177 |
173 |
$616.36 |
| 90670 |
|
619 |
606 |
$388.68 |
| 0064A |
|
15 |
14 |
$240.00 |
| 91300 |
|
146 |
131 |
$215.38 |
| 1125F |
|
3,609 |
3,128 |
$211.37 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
274 |
257 |
$211.37 |
| 81025 |
|
59 |
56 |
$205.37 |
| 90651 |
|
170 |
166 |
$205.05 |
| 0012A |
|
15 |
15 |
$200.00 |
| 90734 |
|
240 |
235 |
$121.86 |
| 90688 |
|
136 |
131 |
$57.83 |
| 90744 |
|
161 |
156 |
$32.42 |
| 36415 |
Collection of venous blood by venipuncture |
1,270 |
1,144 |
$27.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
400 |
362 |
$20.78 |
| 90658 |
|
497 |
486 |
$19.84 |
| 99000 |
|
3,896 |
3,503 |
$6.71 |
| 81003 |
|
239 |
209 |
$3.76 |
| 90698 |
|
565 |
551 |
$0.36 |
| 90633 |
|
256 |
250 |
$0.20 |
| 90710 |
|
238 |
231 |
$0.14 |
| 90696 |
|
70 |
67 |
$0.04 |
| 90681 |
|
12 |
12 |
$0.01 |
| 3008F |
|
8,084 |
6,815 |
$0.00 |
| 3079F |
|
1,621 |
1,456 |
$0.00 |
| 3074F |
|
5,737 |
5,108 |
$0.00 |
| 1034F |
|
729 |
588 |
$0.00 |
| 3352F |
|
377 |
355 |
$0.00 |
| 3351F |
|
1,389 |
1,306 |
$0.00 |
| 1000F |
|
8,572 |
7,331 |
$0.00 |
| 4000F |
|
412 |
351 |
$0.00 |
| 1126F |
|
5,709 |
5,229 |
$0.00 |
| 2001F |
|
3,784 |
3,252 |
$0.00 |
| 1220F |
|
1,556 |
1,390 |
$0.00 |
| 3080F |
|
130 |
104 |
$0.00 |
| 1036F |
|
1,461 |
1,267 |
$0.00 |
| 91301 |
|
65 |
62 |
$0.00 |
| 3075F |
|
591 |
537 |
$0.00 |
| 2000F |
|
3,388 |
2,913 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
13 |
12 |
$0.00 |
| 0513F |
|
22 |
18 |
$0.00 |
| 3353F |
|
164 |
148 |
$0.00 |
| 90657 |
|
61 |
60 |
$0.00 |
| 3044F |
|
20 |
15 |
$0.00 |
| 90619 |
|
53 |
53 |
$0.00 |
| D1330 |
|
14 |
14 |
$0.00 |
| 3078F |
|
5,004 |
4,476 |
$0.00 |
| 1159F |
|
8,696 |
7,569 |
$0.00 |
| 1160F |
|
8,674 |
7,551 |
$0.00 |
| 4004F |
|
1,566 |
1,349 |
$0.00 |
| 3077F |
|
277 |
232 |
$0.00 |
| 3210F |
|
306 |
263 |
$0.00 |
| 0521F |
|
76 |
71 |
$0.00 |
| 2028F |
|
77 |
72 |
$0.00 |
| 1033F |
|
35 |
31 |
$0.00 |
| 3725F |
|
79 |
77 |
$0.00 |
| 90649 |
|
19 |
17 |
$0.00 |
| 90473 |
|
12 |
12 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
28 |
28 |
$0.00 |