| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
5,854 |
4,594 |
$238K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,797 |
12,620 |
$215K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,505 |
1,326 |
$88K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,920 |
1,349 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
1,819 |
1,324 |
$38K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,008 |
1,755 |
$34K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
594 |
459 |
$29K |
| 99490 |
Ccm add 20min |
3,103 |
2,484 |
$26K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,888 |
1,688 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,093 |
856 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,552 |
1,384 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
846 |
442 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
171 |
168 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
185 |
$7K |
| D1110 |
Prophylaxis - adult |
459 |
434 |
$6K |
| 90686 |
|
3,011 |
2,818 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
102 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
113 |
$4K |
| 99460 |
|
138 |
100 |
$3K |
| 99462 |
|
185 |
97 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,683 |
6,558 |
$2K |
| D1206 |
Topical application of fluoride varnish |
1,876 |
1,530 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,652 |
2,986 |
$2K |
| D1330 |
|
1,854 |
1,567 |
$2K |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
1,320 |
442 |
$2K |
| 99441 |
|
598 |
529 |
$1K |
| D1351 |
Sealant - per tooth |
114 |
42 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$1K |
| D1120 |
Prophylaxis - child |
515 |
466 |
$1K |
| 0012A |
|
31 |
31 |
$710.88 |
| D0191 |
|
410 |
296 |
$673.83 |
| D9995 |
|
113 |
110 |
$569.09 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
46 |
42 |
$561.66 |
| D0220 |
Intraoral - periapical first radiographic image |
2,229 |
1,910 |
$478.04 |
| 99442 |
|
73 |
70 |
$386.90 |
| 1000F |
|
29,825 |
23,690 |
$376.97 |
| 0502F |
|
4,906 |
3,805 |
$291.24 |
| 3351F |
|
22,616 |
17,962 |
$267.83 |
| 90832 |
Psychotherapy, 30 minutes with patient |
14 |
12 |
$255.00 |
| D0274 |
Bitewings - four radiographic images |
874 |
843 |
$236.82 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
10,040 |
8,245 |
$220.07 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
18 |
18 |
$191.47 |
| 0011A |
|
20 |
20 |
$177.33 |
| 99188 |
|
301 |
267 |
$152.37 |
| 1039F |
|
113 |
38 |
$98.76 |
| 90670 |
|
874 |
807 |
$84.06 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$78.64 |
| 3008F |
|
33,228 |
26,549 |
$54.93 |
| 90723 |
|
434 |
399 |
$50.00 |
| 92551 |
|
3,069 |
2,504 |
$40.00 |
| 83026 |
|
156 |
141 |
$36.15 |
| 81002 |
|
110 |
74 |
$33.85 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
58 |
56 |
$31.28 |
| 90474 |
|
81 |
77 |
$28.00 |
| 1160F |
|
17,882 |
13,933 |
$24.94 |
| 90633 |
|
86 |
74 |
$19.03 |
| 90685 |
|
12 |
12 |
$18.00 |
| 81025 |
|
57 |
39 |
$14.73 |
| 1036F |
|
19,728 |
15,570 |
$2.09 |
| 3074F |
|
18,412 |
14,575 |
$1.96 |
| 2001F |
|
31,507 |
25,107 |
$0.11 |
| 99173 |
|
3,152 |
2,555 |
$0.00 |
| 4035F |
|
4,097 |
3,650 |
$0.00 |
| 1159F |
|
13,091 |
10,762 |
$0.00 |
| 4004F |
|
1,558 |
1,244 |
$0.00 |
| 3078F |
|
14,567 |
11,493 |
$0.00 |
| 1033F |
|
1,849 |
1,713 |
$0.00 |
| 1158F |
|
6,573 |
5,464 |
$0.00 |
| 4040F |
|
596 |
531 |
$0.00 |
| 3015F |
|
87 |
61 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |
| 0556F |
|
236 |
189 |
$0.00 |
| 90681 |
|
86 |
83 |
$0.00 |
| D0330 |
Panoramic radiographic image |
18 |
16 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
12 |
$0.00 |
| 4158F |
|
12 |
12 |
$0.00 |
| 90473 |
|
15 |
15 |
$0.00 |
| D1354 |
|
61 |
13 |
$0.00 |
| 4013F |
|
16 |
12 |
$0.00 |
| 2028F |
|
18 |
17 |
$0.00 |
| 3079F |
|
3,747 |
3,037 |
$0.00 |
| 1126F |
|
8,182 |
6,733 |
$0.00 |
| 1030F |
|
2,884 |
2,635 |
$0.00 |
| 4037F |
|
2,852 |
2,614 |
$0.00 |
| 1101F |
|
2,103 |
1,742 |
$0.00 |
| 1111F |
|
1,122 |
900 |
$0.00 |
| 1170F |
|
446 |
346 |
$0.00 |
| 1125F |
|
4,010 |
2,564 |
$0.00 |
| 0513F |
|
2,191 |
1,736 |
$0.00 |
| 90647 |
|
416 |
387 |
$0.00 |
| 3075F |
|
681 |
591 |
$0.00 |
| 1022F |
|
683 |
617 |
$0.00 |
| 1034F |
|
1,375 |
1,165 |
$0.00 |
| 3352F |
|
591 |
507 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
18 |
13 |
$0.00 |
| D0603 |
|
268 |
227 |
$0.00 |
| 0503F |
|
15 |
12 |
$0.00 |
| 1005F |
|
26 |
26 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
34 |
34 |
$0.00 |
| 4086F |
|
17 |
13 |
$0.00 |
| 90651 |
|
38 |
38 |
$0.00 |
| 0500F |
|
21 |
13 |
$0.00 |
| 4000F |
|
15 |
12 |
$0.00 |