| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,729 |
5,303 |
$695K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,817 |
6,197 |
$626K |
| H1000 |
Prenatal care, at-risk assessment |
5,628 |
5,049 |
$577K |
| D0190 |
|
10,305 |
10,236 |
$448K |
| D1110 |
Prophylaxis - adult |
4,885 |
4,874 |
$398K |
| D1120 |
Prophylaxis - child |
6,073 |
6,047 |
$379K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,705 |
6,674 |
$273K |
| D0274 |
Bitewings - four radiographic images |
7,105 |
7,092 |
$236K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,382 |
6,933 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
10,441 |
10,413 |
$226K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,738 |
5,683 |
$201K |
| D1351 |
Sealant - per tooth |
5,878 |
2,703 |
$156K |
| D1206 |
Topical application of fluoride varnish |
21,316 |
21,201 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
943 |
802 |
$89K |
| D0240 |
|
2,572 |
2,535 |
$65K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
794 |
793 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,099 |
1,080 |
$52K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
667 |
666 |
$49K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,370 |
4,331 |
$40K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
274 |
274 |
$21K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
274 |
265 |
$19K |
| D0272 |
Bitewings - two radiographic images |
7,601 |
7,580 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
619 |
602 |
$18K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,190 |
1,171 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
101 |
$16K |
| 99381 |
|
334 |
320 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
377 |
327 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
330 |
330 |
$8K |
| D1330 |
|
11,204 |
11,165 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
7,125 |
7,051 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
98 |
92 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$4K |
| 99188 |
|
132 |
132 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
83 |
83 |
$2K |
| 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 |
1,385 |
1,092 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
15 |
15 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
12 |
$1K |
| 59025 |
Fetal non-stress test |
47 |
24 |
$679.45 |
| D0999 |
Unspecified diagnostic procedure, by report |
30 |
30 |
$600.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
47 |
34 |
$517.49 |
| 0012A |
|
15 |
15 |
$440.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
47 |
46 |
$436.48 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
14 |
14 |
$344.26 |
| 90686 |
|
1,023 |
1,000 |
$329.18 |
| D1354 |
|
45 |
31 |
$264.84 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
174 |
136 |
$225.00 |
| D4346 |
|
14 |
14 |
$187.25 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
23 |
23 |
$160.08 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
14 |
14 |
$139.02 |
| 81003 |
|
51 |
50 |
$91.25 |
| D0603 |
|
51 |
51 |
$50.00 |
| 99173 |
|
3,328 |
3,282 |
$10.00 |
| 3008F |
|
15,036 |
14,166 |
$1.91 |
| 3074F |
|
779 |
742 |
$0.00 |
| 1036F |
|
865 |
767 |
$0.00 |
| 1000F |
|
1,782 |
1,530 |
$0.00 |
| 92551 |
|
2,720 |
2,685 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
845 |
838 |
$0.00 |
| 36410 |
|
26 |
25 |
$0.00 |
| 1126F |
|
92 |
92 |
$0.00 |
| 3075F |
|
25 |
25 |
$0.00 |
| 0513F |
|
194 |
183 |
$0.00 |
| 90656 |
|
57 |
57 |
$0.00 |
| 1111F |
|
53 |
52 |
$0.00 |
| 90674 |
|
104 |
104 |
$0.00 |
| 90697 |
|
40 |
40 |
$0.00 |
| 90651 |
|
54 |
54 |
$0.00 |
| 3079F |
|
163 |
125 |
$0.00 |
| 1125F |
|
32 |
32 |
$0.00 |
| 1170F |
|
12 |
12 |
$0.00 |
| 1160F |
|
280 |
277 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
398 |
327 |
$0.00 |
| 3725F |
|
313 |
281 |
$0.00 |
| 90670 |
|
40 |
40 |
$0.00 |
| 4004F |
|
140 |
114 |
$0.00 |
| 1039F |
|
95 |
95 |
$0.00 |
| 1159F |
|
255 |
251 |
$0.00 |
| 3078F |
|
462 |
399 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
179 |
141 |
$0.00 |
| 0502F |
|
132 |
110 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 0521F |
|
53 |
53 |
$0.00 |
| 3015F |
|
55 |
43 |
$0.00 |
| 90655 |
|
81 |
81 |
$0.00 |
| 90715 |
|
34 |
20 |
$0.00 |