| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
24,082 |
18,724 |
$2.67M |
| T1015 |
Clinic visit/encounter, all-inclusive |
13,612 |
10,535 |
$2.34M |
| D0999 |
Unspecified diagnostic procedure, by report |
6,947 |
6,061 |
$1.37M |
| D0603 |
|
1,690 |
1,564 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
4,961 |
3,218 |
$4K |
| D1110 |
Prophylaxis - adult |
4,056 |
3,770 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,797 |
1,385 |
$2K |
| D1206 |
Topical application of fluoride varnish |
3,199 |
2,880 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
3,933 |
3,652 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
659 |
479 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,237 |
3,006 |
$2K |
| D0330 |
Panoramic radiographic image |
3,778 |
3,370 |
$852.26 |
| D0140 |
Limited oral evaluation - problem focused |
3,168 |
2,825 |
$711.75 |
| D1120 |
Prophylaxis - child |
325 |
281 |
$659.95 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,021 |
3,251 |
$637.84 |
| 0011A |
|
46 |
40 |
$600.00 |
| D0274 |
Bitewings - four radiographic images |
1,998 |
1,925 |
$560.08 |
| D0220 |
Intraoral - periapical first radiographic image |
3,843 |
3,453 |
$386.74 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
3,982 |
3,211 |
$377.29 |
| D0602 |
|
107 |
97 |
$280.00 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
3,960 |
3,193 |
$242.61 |
| 0012A |
|
17 |
14 |
$240.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,327 |
1,982 |
$211.82 |
| D0601 |
|
61 |
53 |
$185.00 |
| D0270 |
|
616 |
588 |
$117.63 |
| 87428 |
|
386 |
336 |
$115.01 |
| D4341 |
|
1,468 |
696 |
$107.74 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
173 |
161 |
$98.18 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
191 |
179 |
$85.86 |
| 90834 |
Psychotherapy, 45 minutes with patient |
134 |
74 |
$55.71 |
| 90686 |
|
26 |
26 |
$52.50 |
| 80305 |
|
316 |
293 |
$43.05 |
| 99201 |
|
1,087 |
822 |
$36.82 |
| D0272 |
Bitewings - two radiographic images |
31 |
30 |
$35.10 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,630 |
1,334 |
$31.36 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
390 |
344 |
$24.16 |
| D7140 |
Extraction, erupted tooth or exposed root |
3,552 |
1,769 |
$20.46 |
| 86803 |
|
28 |
28 |
$20.28 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
179 |
166 |
$15.27 |
| 86703 |
|
75 |
72 |
$13.57 |
| 81003 |
|
36 |
33 |
$3.18 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
515 |
427 |
$2.94 |
| D0230 |
Intraoral - periapical each additional radiographic image |
768 |
351 |
$2.04 |
| D4910 |
|
298 |
294 |
$1.85 |
| D2332 |
|
45 |
36 |
$0.27 |
| D2331 |
|
52 |
40 |
$0.25 |
| D2330 |
|
30 |
25 |
$0.17 |
| D2335 |
|
25 |
19 |
$0.11 |
| D0170 |
|
20 |
12 |
$0.09 |
| D2740 |
Crown - porcelain/ceramic |
40 |
24 |
$0.08 |
| D2950 |
|
23 |
12 |
$0.06 |
| D2394 |
|
12 |
12 |
$0.06 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$0.05 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
216 |
198 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
167 |
140 |
$0.00 |
| 91301 |
|
70 |
61 |
$0.00 |
| 99383 |
|
22 |
19 |
$0.00 |
| 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 |
22 |
17 |
$0.00 |
| 90651 |
|
22 |
17 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
12 |
$0.00 |
| 90734 |
|
16 |
13 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
15 |
15 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,225 |
1,130 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
36 |
29 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
376 |
294 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
54 |
54 |
$0.00 |
| 80061 |
Lipid panel |
99 |
91 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
39 |
37 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
33 |
30 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$0.00 |