| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,383 |
3,618 |
$687K |
| D1120 |
Prophylaxis - child |
5,275 |
5,000 |
$662K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,585 |
3,737 |
$647K |
| D1206 |
Topical application of fluoride varnish |
9,403 |
8,986 |
$491K |
| D1110 |
Prophylaxis - adult |
2,900 |
2,764 |
$342K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,832 |
1,680 |
$309K |
| D0274 |
Bitewings - four radiographic images |
2,307 |
2,202 |
$185K |
| 90837 |
Psychotherapy, 53 minutes with patient |
696 |
489 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
925 |
857 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
851 |
633 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,445 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,074 |
1,999 |
$68K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
300 |
297 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
2,571 |
2,415 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
383 |
297 |
$45K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
194 |
191 |
$37K |
| D0272 |
Bitewings - two radiographic images |
579 |
542 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
117 |
$17K |
| D1351 |
Sealant - per tooth |
2,354 |
883 |
$15K |
| 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 |
2,478 |
1,687 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
109 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
38 |
38 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,980 |
1,116 |
$5K |
| 99173 |
|
278 |
278 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$2K |
| D0270 |
|
60 |
54 |
$1K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$606.84 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
146 |
127 |
$377.82 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
179 |
170 |
$203.06 |
| 36415 |
Collection of venous blood by venipuncture |
531 |
490 |
$152.14 |
| 90686 |
|
269 |
252 |
$145.13 |
| G0008 |
Administration of influenza virus vaccine |
19 |
17 |
$66.26 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
543 |
515 |
$51.72 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
12 |
$11.17 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
93 |
87 |
$0.00 |
| 81003 |
|
16 |
13 |
$0.00 |
| 90688 |
|
26 |
26 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
17 |
17 |
$0.00 |