| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,803 |
5,383 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,449 |
1,430 |
$42K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
399 |
388 |
$30K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
346 |
332 |
$26K |
| D1110 |
Prophylaxis - adult |
713 |
711 |
$24K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
315 |
309 |
$23K |
| D1330 |
|
2,433 |
2,418 |
$21K |
| D1206 |
Topical application of fluoride varnish |
2,436 |
2,418 |
$20K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
565 |
529 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
837 |
832 |
$18K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
231 |
225 |
$16K |
| D1120 |
Prophylaxis - child |
1,416 |
1,404 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
143 |
$9K |
| D0330 |
Panoramic radiographic image |
315 |
309 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
114 |
110 |
$7K |
| D0274 |
Bitewings - four radiographic images |
909 |
895 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,190 |
1,671 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,147 |
2,105 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
138 |
$5K |
| 99385 |
|
64 |
62 |
$5K |
| D1351 |
Sealant - per tooth |
244 |
66 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
541 |
505 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
86 |
84 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
805 |
753 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
432 |
397 |
$4K |
| D0272 |
Bitewings - two radiographic images |
412 |
408 |
$3K |
| 99188 |
|
404 |
386 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
320 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
38 |
36 |
$3K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
190 |
179 |
$2K |
| D1999 |
|
28 |
28 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
28 |
13 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
203 |
197 |
$935.87 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
188 |
176 |
$934.31 |
| 99383 |
|
17 |
14 |
$868.61 |
| D9999 |
Unspecified adjunctive procedure, by report |
59 |
59 |
$765.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
12 |
$569.86 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
222 |
215 |
$344.54 |
| 36415 |
Collection of venous blood by venipuncture |
842 |
804 |
$221.75 |
| 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 |
111 |
82 |
$174.85 |
| D9310 |
|
228 |
228 |
$174.83 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
20 |
15 |
$111.98 |
| 93000 |
|
13 |
13 |
$101.60 |
| 1036F |
|
4,426 |
3,688 |
$99.37 |
| 81025 |
|
21 |
20 |
$73.64 |
| 90686 |
|
45 |
43 |
$72.60 |
| 3008F |
|
7,061 |
5,855 |
$20.00 |
| 81002 |
|
13 |
13 |
$14.63 |
| 82962 |
|
13 |
12 |
$13.38 |
| D0602 |
|
30 |
30 |
$7.00 |
| 1126F |
|
2,426 |
2,232 |
$0.00 |
| 3075F |
|
152 |
147 |
$0.00 |
| 96127 |
|
3,412 |
2,871 |
$0.00 |
| 3074F |
|
3,450 |
3,219 |
$0.00 |
| 1034F |
|
312 |
264 |
$0.00 |
| 92551 |
|
1,243 |
1,006 |
$0.00 |
| 90651 |
|
139 |
132 |
$0.00 |
| 3079F |
|
1,076 |
946 |
$0.00 |
| 3080F |
|
89 |
83 |
$0.00 |
| 1125F |
|
35 |
34 |
$0.00 |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
14 |
14 |
$0.00 |
| 90677 |
|
13 |
12 |
$0.00 |
| 90633 |
|
159 |
145 |
$0.00 |
| 3725F |
|
4,791 |
4,001 |
$0.00 |
| 3078F |
|
3,067 |
2,617 |
$0.00 |
| 1160F |
|
2,620 |
2,426 |
$0.00 |
| 1159F |
|
2,658 |
2,460 |
$0.00 |
| 3077F |
|
201 |
179 |
$0.00 |
| 90648 |
|
68 |
58 |
$0.00 |
| 90734 |
|
56 |
55 |
$0.00 |
| 99173 |
|
1,171 |
940 |
$0.00 |
| 90461 |
|
201 |
185 |
$0.00 |
| 90670 |
|
225 |
198 |
$0.00 |