| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,530 |
8,847 |
$374K |
| H1000 |
Prenatal care, at-risk assessment |
3,861 |
2,795 |
$273K |
| D1110 |
Prophylaxis - adult |
3,502 |
3,376 |
$109K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,119 |
1,048 |
$99K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,010 |
919 |
$84K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,868 |
1,720 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,650 |
1,149 |
$61K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,364 |
1,128 |
$57K |
| D0330 |
Panoramic radiographic image |
1,120 |
1,091 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
562 |
426 |
$38K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
373 |
353 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
670 |
649 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,491 |
1,571 |
$21K |
| D1120 |
Prophylaxis - child |
288 |
284 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
168 |
164 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
488 |
357 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,283 |
1,253 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,254 |
1,218 |
$11K |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
173 |
52 |
$7K |
| D1206 |
Topical application of fluoride varnish |
3,225 |
3,122 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,360 |
1,317 |
$6K |
| 98940 |
|
86 |
28 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
97 |
87 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
48 |
38 |
$4K |
| 99215 |
Prolong outpt/office vis |
55 |
50 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,525 |
3,171 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,760 |
1,626 |
$3K |
| D1351 |
Sealant - per tooth |
188 |
39 |
$3K |
| 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 |
741 |
496 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
1,079 |
1,044 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
26 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,440 |
2,358 |
$1K |
| 90686 |
|
1,152 |
997 |
$945.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
12 |
$816.76 |
| 59430 |
|
16 |
14 |
$789.66 |
| 0012A |
|
28 |
28 |
$766.53 |
| D4355 |
|
24 |
24 |
$655.38 |
| 3074F |
|
276 |
243 |
$575.00 |
| 0011A |
|
28 |
27 |
$440.44 |
| 81003 |
|
3,018 |
2,203 |
$327.27 |
| 99188 |
|
74 |
74 |
$266.11 |
| 85018 |
|
1,125 |
1,041 |
$218.06 |
| D0270 |
|
333 |
325 |
$210.32 |
| D1330 |
|
3,749 |
3,621 |
$174.36 |
| 90670 |
|
866 |
825 |
$150.00 |
| 90698 |
|
196 |
189 |
$143.76 |
| 90651 |
|
38 |
32 |
$110.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
128 |
116 |
$109.12 |
| 0002A |
|
14 |
14 |
$85.17 |
| 90633 |
|
216 |
194 |
$75.00 |
| 0001A |
|
19 |
19 |
$67.76 |
| 90688 |
|
15 |
15 |
$60.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
54 |
50 |
$32.56 |
| D3120 |
|
16 |
12 |
$32.00 |
| 90674 |
|
23 |
21 |
$30.00 |
| 90715 |
|
16 |
16 |
$15.00 |
| 90734 |
|
58 |
49 |
$10.00 |
| 90685 |
|
16 |
15 |
$5.00 |
| 1159F |
|
607 |
532 |
$0.00 |
| D0350 |
|
314 |
310 |
$0.00 |
| 1160F |
|
607 |
532 |
$0.00 |
| 90648 |
|
22 |
14 |
$0.00 |
| 3078F |
|
118 |
97 |
$0.00 |
| 91300 |
|
64 |
57 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
59 |
52 |
$0.00 |
| 1036F |
|
124 |
107 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
198 |
195 |
$0.00 |
| D1310 |
|
1,162 |
1,128 |
$0.00 |
| 90744 |
|
60 |
55 |
$0.00 |
| 3079F |
|
43 |
41 |
$0.00 |
| 1034F |
|
17 |
14 |
$0.00 |
| 1126F |
|
275 |
250 |
$0.00 |
| 1000F |
|
133 |
115 |
$0.00 |
| 91301 |
|
57 |
56 |
$0.00 |
| 90680 |
|
119 |
112 |
$0.00 |
| D0240 |
|
128 |
98 |
$0.00 |
| 92551 |
|
12 |
12 |
$0.00 |
| 1125F |
|
16 |
16 |
$0.00 |
| 90697 |
|
12 |
12 |
$0.00 |