| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
308,744 |
202,626 |
$1.39M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,369 |
4,361 |
$330K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,826 |
6,035 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,034 |
2,929 |
$85K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,724 |
2,162 |
$84K |
| D1120 |
Prophylaxis - child |
2,632 |
2,485 |
$76K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
828 |
758 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,764 |
3,567 |
$63K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
591 |
427 |
$58K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,394 |
2,087 |
$54K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
409 |
384 |
$38K |
| D1351 |
Sealant - per tooth |
1,311 |
395 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
769 |
697 |
$33K |
| D1110 |
Prophylaxis - adult |
872 |
833 |
$33K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
346 |
306 |
$31K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
262 |
238 |
$26K |
| 0001A |
|
503 |
327 |
$20K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
482 |
391 |
$20K |
| 0002A |
|
436 |
290 |
$18K |
| 0012A |
|
294 |
254 |
$14K |
| D0272 |
Bitewings - two radiographic images |
781 |
723 |
$14K |
| 0011A |
|
353 |
291 |
$13K |
| 81025 |
|
1,816 |
1,505 |
$13K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
385 |
327 |
$12K |
| 96127 |
|
2,513 |
2,307 |
$11K |
| 0072A |
|
236 |
131 |
$10K |
| 0071A |
|
256 |
140 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
119 |
93 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,062 |
864 |
$9K |
| 87210 |
|
1,755 |
1,399 |
$7K |
| 36415 |
Collection of venous blood by venipuncture |
3,036 |
2,426 |
$6K |
| 90651 |
|
238 |
214 |
$5K |
| 82120 |
|
1,181 |
938 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
277 |
134 |
$4K |
| 90619 |
|
773 |
660 |
$4K |
| 0064A |
|
95 |
71 |
$4K |
| D0274 |
Bitewings - four radiographic images |
107 |
104 |
$3K |
| 90734 |
|
219 |
201 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
126 |
$3K |
| 81003 |
|
1,886 |
1,495 |
$3K |
| 0004A |
|
54 |
35 |
$2K |
| 99215 |
Prolong outpt/office vis |
27 |
26 |
$2K |
| 90688 |
|
352 |
312 |
$2K |
| 85018 |
|
1,685 |
1,424 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
52 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,210 |
1,741 |
$2K |
| 96160 |
|
544 |
464 |
$2K |
| 90686 |
|
1,906 |
1,733 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| 96161 |
|
395 |
356 |
$1K |
| 90715 |
|
401 |
349 |
$1K |
| 99384 |
|
12 |
12 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
69 |
64 |
$947.05 |
| 92551 |
|
1,915 |
1,680 |
$834.90 |
| 99406 |
|
98 |
94 |
$790.31 |
| 90620 |
|
32 |
29 |
$720.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,421 |
1,175 |
$716.58 |
| 90480 |
|
17 |
13 |
$675.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
15 |
$667.16 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,422 |
1,177 |
$645.40 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
41 |
27 |
$391.92 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,397 |
1,166 |
$377.54 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$180.40 |
| 99173 |
|
2,169 |
1,906 |
$136.43 |
| 86592 |
|
1,385 |
1,156 |
$101.80 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
429 |
357 |
$99.12 |
| 86593 |
|
1,384 |
1,155 |
$94.12 |
| 91300 |
|
1,013 |
639 |
$33.60 |
| 85027 |
|
406 |
332 |
$32.43 |
| 91307 |
|
496 |
299 |
$31.39 |
| 86803 |
|
35 |
29 |
$18.15 |
| 87340 |
|
364 |
286 |
$11.83 |
| D0601 |
|
460 |
440 |
$0.00 |
| D1330 |
|
810 |
713 |
$0.00 |
| 86762 |
|
59 |
39 |
$0.00 |
| D0603 |
|
177 |
141 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
372 |
294 |
$0.00 |
| 86901 |
|
293 |
216 |
$0.00 |
| D9912 |
|
1,220 |
1,100 |
$0.00 |
| D1310 |
|
61 |
57 |
$0.00 |
| 91301 |
|
733 |
576 |
$0.00 |
| 91306 |
|
75 |
67 |
$0.00 |
| 86850 |
|
336 |
260 |
$0.00 |
| 0500F |
|
12 |
12 |
$0.00 |
| 90647 |
|
125 |
125 |
$0.00 |
| 90723 |
|
37 |
37 |
$0.00 |
| D0602 |
|
55 |
55 |
$0.00 |
| 86900 |
|
289 |
215 |
$0.00 |
| 90670 |
|
320 |
302 |
$0.00 |
| 83655 |
|
210 |
202 |
$0.00 |
| 90633 |
|
115 |
110 |
$0.00 |
| 86787 |
|
65 |
40 |
$0.00 |
| 90710 |
|
86 |
79 |
$0.00 |