| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,371 |
3,930 |
$109K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,104 |
1,742 |
$77K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
289 |
258 |
$19K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
592 |
567 |
$13K |
| H1000 |
Prenatal care, at-risk assessment |
379 |
236 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
102 |
102 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
687 |
659 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
68 |
68 |
$6K |
| D1110 |
Prophylaxis - adult |
274 |
217 |
$5K |
| D0330 |
Panoramic radiographic image |
313 |
309 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
146 |
127 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
613 |
570 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
257 |
144 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
405 |
298 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
242 |
149 |
$2K |
| D0274 |
Bitewings - four radiographic images |
461 |
443 |
$2K |
| 81025 |
|
492 |
437 |
$1K |
| 90461 |
|
486 |
427 |
$1K |
| D1120 |
Prophylaxis - child |
101 |
100 |
$1K |
| 99384 |
|
14 |
14 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
268 |
218 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
39 |
$923.10 |
| 82962 |
|
706 |
573 |
$818.71 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
15 |
12 |
$688.50 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
27 |
$652.40 |
| 81003 |
|
415 |
335 |
$511.65 |
| 83655 |
|
56 |
54 |
$334.90 |
| 81000 |
|
246 |
176 |
$265.80 |
| 85018 |
|
236 |
235 |
$249.33 |
| 90686 |
|
79 |
72 |
$220.00 |
| H0049 |
Alcohol and/or drug screening |
19 |
15 |
$173.78 |
| D0120 |
Periodic oral evaluation - established patient |
52 |
48 |
$148.45 |
| D1206 |
Topical application of fluoride varnish |
304 |
290 |
$145.76 |
| 90670 |
|
24 |
24 |
$140.00 |
| D1330 |
|
238 |
227 |
$118.95 |
| 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 |
462 |
372 |
$104.40 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
12 |
$95.54 |
| 90715 |
|
13 |
13 |
$60.00 |
| D0220 |
Intraoral - periapical first radiographic image |
543 |
511 |
$37.10 |
| 90671 |
|
30 |
26 |
$20.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
108 |
100 |
$20.00 |
| 3044F |
|
96 |
88 |
$20.00 |
| 96127 |
|
710 |
583 |
$1.82 |
| 1159F |
|
1,981 |
1,767 |
$0.01 |
| 1160F |
|
521 |
470 |
$0.01 |
| 4013F |
|
109 |
82 |
$0.00 |
| 3078F |
|
1,611 |
1,152 |
$0.00 |
| 99177 |
|
322 |
260 |
$0.00 |
| 3511F |
|
87 |
80 |
$0.00 |
| 90710 |
|
32 |
32 |
$0.00 |
| 3028F |
|
135 |
107 |
$0.00 |
| 99173 |
|
832 |
696 |
$0.00 |
| 3077F |
|
195 |
162 |
$0.00 |
| 90734 |
|
66 |
41 |
$0.00 |
| 90648 |
|
13 |
13 |
$0.00 |
| 90633 |
|
38 |
38 |
$0.00 |
| 4035F |
|
57 |
54 |
$0.00 |
| 1039F |
|
15 |
15 |
$0.00 |
| 2010F |
|
2,401 |
1,898 |
$0.00 |
| 2001F |
|
2,109 |
1,460 |
$0.00 |
| 3079F |
|
511 |
407 |
$0.00 |
| 92551 |
|
835 |
755 |
$0.00 |
| 3074F |
|
2,043 |
1,636 |
$0.00 |
| 3008F |
|
5,105 |
3,705 |
$0.00 |
| 2000F |
|
810 |
570 |
$0.00 |
| 1030F |
|
1,254 |
958 |
$0.00 |
| D1310 |
|
132 |
131 |
$0.00 |
| 1111F |
|
1,638 |
1,345 |
$0.00 |
| 1000F |
|
766 |
540 |
$0.00 |
| 1036F |
|
420 |
295 |
$0.00 |
| 4010F |
|
71 |
54 |
$0.00 |
| 2016F |
|
93 |
73 |
$0.00 |
| 3075F |
|
182 |
155 |
$0.00 |
| 1034F |
|
19 |
12 |
$0.00 |
| 36416 |
|
30 |
26 |
$0.00 |
| 3048F |
|
15 |
12 |
$0.00 |
| 1220F |
|
51 |
50 |
$0.00 |
| 90696 |
|
14 |
14 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
40 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
36 |
29 |
$0.00 |
| 1005F |
|
78 |
61 |
$0.00 |
| 3080F |
|
168 |
128 |
$0.00 |
| 1126F |
|
56 |
46 |
$0.00 |
| G9432 |
Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented |
18 |
17 |
$0.00 |
| 0513F |
|
59 |
54 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
26 |
26 |
$0.00 |
| 90651 |
|
49 |
44 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| 1125F |
|
17 |
16 |
$0.00 |
| 3514F |
|
12 |
12 |
$0.00 |