| Code | Description | Claims | Beneficiaries | Total Paid |
| 3008F |
|
131,209 |
64,707 |
$3.93M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
79,322 |
49,222 |
$3.10M |
| D0120 |
Periodic oral evaluation - established patient |
62,635 |
19,850 |
$2.01M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14,268 |
9,850 |
$724K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18,742 |
11,129 |
$668K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,090 |
6,811 |
$661K |
| 90834 |
Psychotherapy, 45 minutes with patient |
5,746 |
2,473 |
$565K |
| D1110 |
Prophylaxis - adult |
14,514 |
14,384 |
$561K |
| 99441 |
|
5,922 |
4,455 |
$470K |
| 90832 |
Psychotherapy, 30 minutes with patient |
5,517 |
2,329 |
$470K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,961 |
2,291 |
$305K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,792 |
2,605 |
$305K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,330 |
6,046 |
$300K |
| D0274 |
Bitewings - four radiographic images |
14,757 |
14,276 |
$292K |
| D0140 |
Limited oral evaluation - problem focused |
7,367 |
3,201 |
$285K |
| D1120 |
Prophylaxis - child |
8,346 |
8,144 |
$275K |
| D0220 |
Intraoral - periapical first radiographic image |
22,135 |
20,597 |
$268K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,744 |
688 |
$220K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,981 |
3,072 |
$201K |
| 94760 |
|
31,112 |
25,393 |
$165K |
| D1351 |
Sealant - per tooth |
3,265 |
846 |
$165K |
| 96127 |
|
10,367 |
7,530 |
$144K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
4,391 |
2,080 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,454 |
9,412 |
$106K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,717 |
2,126 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
3,622 |
3,547 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,571 |
17,279 |
$94K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
895 |
549 |
$64K |
| 92551 |
|
8,827 |
8,760 |
$55K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
460 |
301 |
$54K |
| 90791 |
Psychiatric diagnostic evaluation |
343 |
228 |
$44K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
1,111 |
917 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,441 |
1,441 |
$35K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,333 |
6,298 |
$31K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
909 |
734 |
$27K |
| 86703 |
|
3,174 |
3,106 |
$25K |
| 82962 |
|
11,035 |
9,471 |
$24K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
693 |
426 |
$24K |
| 97802 |
|
1,057 |
902 |
$24K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,871 |
1,808 |
$22K |
| 97803 |
|
1,363 |
1,055 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
296 |
209 |
$20K |
| D4341 |
|
233 |
84 |
$19K |
| 90658 |
|
3,892 |
3,815 |
$18K |
| 0001A |
|
526 |
525 |
$18K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
601 |
281 |
$15K |
| 0002A |
|
413 |
413 |
$14K |
| 0012A |
|
447 |
447 |
$12K |
| 90656 |
|
1,644 |
1,623 |
$12K |
| 0064A |
|
342 |
342 |
$12K |
| 90838 |
|
183 |
109 |
$12K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
166 |
112 |
$11K |
| 0071A |
|
289 |
288 |
$11K |
| 92015 |
Determination of refractive state |
478 |
422 |
$10K |
| 0072A |
|
267 |
267 |
$10K |
| D0330 |
Panoramic radiographic image |
453 |
405 |
$9K |
| 0011A |
|
498 |
498 |
$9K |
| 81000 |
|
4,105 |
3,964 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,374 |
1,371 |
$8K |
| 99215 |
Prolong outpt/office vis |
262 |
193 |
$8K |
| 93000 |
|
502 |
412 |
$8K |
| 81025 |
|
1,575 |
1,501 |
$7K |
| D0272 |
Bitewings - two radiographic images |
418 |
410 |
$5K |
| 99406 |
|
303 |
258 |
$5K |
| D9310 |
|
178 |
171 |
$5K |
| 99173 |
|
5,530 |
5,421 |
$4K |
| 94664 |
|
929 |
821 |
$3K |
| D2330 |
|
50 |
29 |
$3K |
| 99403 |
|
28 |
18 |
$3K |
| D2331 |
|
35 |
15 |
$2K |
| 1159F |
|
1,252 |
1,189 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
1,596 |
1,580 |
$2K |
| 0052A |
|
56 |
56 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| 0134A |
|
53 |
53 |
$2K |
| 99442 |
|
21 |
12 |
$1K |
| 86803 |
|
485 |
485 |
$1K |
| 0054A |
|
32 |
32 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,389 |
1,321 |
$1K |
| 0051A |
|
33 |
33 |
$1K |
| 0074A |
|
25 |
25 |
$922.45 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
2,787 |
2,677 |
$915.76 |
| 99385 |
|
55 |
41 |
$815.36 |
| 90461 |
|
234 |
234 |
$713.11 |
| 0004A |
|
25 |
25 |
$688.73 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
38 |
37 |
$585.33 |
| 99443 |
|
32 |
17 |
$583.75 |
| 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 |
26 |
13 |
$563.54 |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
13 |
$515.52 |
| 0124A |
|
12 |
12 |
$480.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
93 |
93 |
$404.51 |
| 99188 |
|
34 |
34 |
$184.90 |
| 93228 |
|
20 |
20 |
$167.42 |
| 87807 |
|
475 |
454 |
$151.32 |
| 90734 |
|
205 |
203 |
$135.39 |
| D0270 |
|
13 |
13 |
$109.27 |
| 99606 |
|
50 |
50 |
$100.00 |
| 86580 |
|
14 |
14 |
$84.32 |
| 90715 |
|
24 |
24 |
$26.40 |
| 96161 |
|
41 |
41 |
$5.68 |
| 83655 |
|
1,122 |
1,118 |
$5.48 |
| 90655 |
|
139 |
139 |
$0.53 |
| 90670 |
|
94 |
93 |
$0.00 |
| 90633 |
|
115 |
109 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| S3000 |
Diabetic indicator; retinal eye exam, dilated, bilateral |
19 |
19 |
$0.00 |
| 90651 |
|
243 |
243 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
71 |
71 |
$0.00 |
| 90698 |
|
76 |
75 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
140 |
140 |
$0.00 |
| 90744 |
|
37 |
37 |
$0.00 |
| 90620 |
|
12 |
12 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| 90657 |
|
12 |
12 |
$0.00 |