| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
13,021 |
7,552 |
$1.06M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43,763 |
30,269 |
$983K |
| D1120 |
Prophylaxis - child |
9,563 |
9,329 |
$269K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,078 |
2,969 |
$248K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,199 |
3,132 |
$230K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,120 |
2,897 |
$195K |
| D1110 |
Prophylaxis - adult |
3,974 |
3,896 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,311 |
1,790 |
$126K |
| D0330 |
Panoramic radiographic image |
2,038 |
2,025 |
$124K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,713 |
1,854 |
$121K |
| D0240 |
|
3,492 |
2,803 |
$120K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
652 |
482 |
$54K |
| D1206 |
Topical application of fluoride varnish |
14,081 |
13,717 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,424 |
1,088 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
10,276 |
10,022 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,034 |
2,020 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
993 |
614 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
712 |
709 |
$32K |
| 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 |
3,422 |
2,357 |
$31K |
| D1351 |
Sealant - per tooth |
3,100 |
841 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,339 |
690 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
2,557 |
2,504 |
$24K |
| D1354 |
|
4,320 |
1,118 |
$22K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,402 |
964 |
$20K |
| D0274 |
Bitewings - four radiographic images |
2,840 |
2,807 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,084 |
1,959 |
$15K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13,201 |
9,804 |
$13K |
| D0272 |
Bitewings - two radiographic images |
6,315 |
6,175 |
$11K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
6,191 |
4,618 |
$11K |
| 99381 |
|
99 |
89 |
$10K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,106 |
844 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
116 |
103 |
$7K |
| D0191 |
|
510 |
506 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,939 |
4,856 |
$3K |
| 90686 |
|
5,836 |
4,668 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,446 |
2,701 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
62 |
41 |
$2K |
| D1330 |
|
14,326 |
13,978 |
$2K |
| 90651 |
|
881 |
636 |
$2K |
| 0002A |
|
113 |
104 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
164 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
80 |
80 |
$2K |
| 90670 |
|
2,103 |
1,456 |
$1K |
| 0001A |
|
102 |
97 |
$1K |
| D0350 |
|
1,064 |
1,046 |
$910.56 |
| 0072A |
|
28 |
25 |
$777.92 |
| 3074F |
|
463 |
417 |
$725.00 |
| 59430 |
|
12 |
12 |
$707.42 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,747 |
1,289 |
$666.47 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,406 |
1,209 |
$615.31 |
| D0270 |
|
662 |
657 |
$545.45 |
| D4346 |
|
13 |
13 |
$521.87 |
| 81003 |
|
10,908 |
6,302 |
$513.67 |
| 90674 |
|
151 |
135 |
$377.80 |
| 0071A |
|
42 |
31 |
$321.88 |
| 90620 |
|
232 |
167 |
$257.60 |
| 0012A |
|
12 |
12 |
$255.51 |
| 82962 |
|
309 |
239 |
$199.24 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
82 |
55 |
$195.98 |
| 92015 |
Determination of refractive state |
24 |
24 |
$177.09 |
| 85018 |
|
2,635 |
1,763 |
$163.64 |
| 99188 |
|
193 |
191 |
$121.91 |
| 90715 |
|
334 |
230 |
$80.35 |
| 90680 |
|
695 |
478 |
$55.00 |
| D1310 |
|
6,328 |
6,301 |
$43.15 |
| 90633 |
|
268 |
181 |
$41.62 |
| D3120 |
|
32 |
29 |
$32.84 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
243 |
160 |
$25.22 |
| 87430 |
|
49 |
49 |
$16.17 |
| 90734 |
|
703 |
393 |
$5.00 |
| 90723 |
|
999 |
762 |
$0.00 |
| 1036F |
|
174 |
140 |
$0.00 |
| 1000F |
|
192 |
156 |
$0.00 |
| 90647 |
|
994 |
670 |
$0.00 |
| 1126F |
|
550 |
535 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
271 |
261 |
$0.00 |
| 3008F |
|
3,502 |
2,045 |
$0.00 |
| 3079F |
|
49 |
46 |
$0.00 |
| 91307 |
|
179 |
98 |
$0.00 |
| 90656 |
|
60 |
60 |
$0.00 |
| 87428 |
|
152 |
29 |
$0.00 |
| 1125F |
|
39 |
39 |
$0.00 |
| 92551 |
|
20 |
19 |
$0.00 |
| 91301 |
|
72 |
69 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 1160F |
|
1,301 |
1,167 |
$0.00 |
| 91300 |
|
314 |
262 |
$0.00 |
| 3078F |
|
311 |
286 |
$0.00 |
| D0180 |
|
294 |
291 |
$0.00 |
| 1159F |
|
1,302 |
1,167 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
116 |
115 |
$0.00 |
| 87481 |
|
12 |
12 |
$0.00 |
| 81513 |
|
12 |
12 |
$0.00 |
| D9996 |
|
100 |
100 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
42 |
41 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
91 |
89 |
$0.00 |
| 90461 |
|
95 |
89 |
$0.00 |
| 81025 |
|
15 |
12 |
$0.00 |