| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
7,002 |
6,000 |
$1.37M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,045 |
3,742 |
$602K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,459 |
1,315 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
1,305 |
1,297 |
$53K |
| 1000F |
|
2,106 |
1,903 |
$44K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
204 |
202 |
$37K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
158 |
158 |
$30K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
154 |
154 |
$30K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
150 |
150 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
806 |
$26K |
| D1120 |
Prophylaxis - child |
1,179 |
1,176 |
$26K |
| 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 |
1,324 |
1,169 |
$23K |
| 1126F |
|
2,008 |
1,875 |
$15K |
| 99383 |
|
63 |
61 |
$12K |
| 99384 |
|
56 |
56 |
$11K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
56 |
49 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
241 |
$11K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
51 |
51 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,698 |
1,675 |
$4K |
| 1125F |
|
756 |
719 |
$4K |
| 99382 |
|
16 |
16 |
$3K |
| 2000F |
|
3,054 |
2,779 |
$2K |
| D1110 |
Prophylaxis - adult |
128 |
128 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
574 |
564 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
522 |
522 |
$2K |
| 2001F |
|
3,409 |
3,087 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
56 |
45 |
$1K |
| D1206 |
Topical application of fluoride varnish |
400 |
397 |
$865.12 |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$807.60 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$600.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
102 |
102 |
$558.75 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
453 |
444 |
$529.02 |
| 1159F |
|
897 |
872 |
$510.50 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
260 |
255 |
$313.82 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$300.20 |
| 1220F |
|
1,083 |
1,024 |
$260.73 |
| D0274 |
Bitewings - four radiographic images |
509 |
507 |
$200.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
65 |
65 |
$183.39 |
| 90686 |
|
173 |
169 |
$81.08 |
| 81002 |
|
50 |
47 |
$66.00 |
| 36415 |
Collection of venous blood by venipuncture |
32 |
32 |
$29.56 |
| 3044F |
|
371 |
335 |
$7.39 |
| 3210F |
|
483 |
439 |
$7.39 |
| 3008F |
|
3,139 |
2,856 |
$0.08 |
| 1160F |
|
896 |
871 |
$0.04 |
| 3074F |
|
2,498 |
2,299 |
$0.03 |
| 3078F |
|
1,916 |
1,787 |
$0.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,150 |
1,055 |
$0.00 |
| 3075F |
|
235 |
230 |
$0.00 |
| 4000F |
|
863 |
827 |
$0.00 |
| 3079F |
|
968 |
907 |
$0.00 |
| 3080F |
|
59 |
58 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
101 |
98 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
29 |
29 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
31 |
31 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
15 |
13 |
$0.00 |
| 87807 |
|
12 |
12 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |
| 3046F |
|
14 |
13 |
$0.00 |
| 3077F |
|
157 |
147 |
$0.00 |
| 90461 |
|
152 |
152 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
216 |
216 |
$0.00 |
| 90715 |
|
64 |
63 |
$0.00 |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$0.00 |
| 3051F |
|
13 |
12 |
$0.00 |