| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
233,711 |
208,451 |
$1.27M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,059 |
1,542 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
3,872 |
3,831 |
$118K |
| D1120 |
Prophylaxis - child |
3,105 |
3,065 |
$99K |
| D1110 |
Prophylaxis - adult |
1,990 |
1,947 |
$89K |
| T1002 |
Rn services, up to 15 minutes |
1,973 |
1,463 |
$82K |
| D2140 |
|
984 |
760 |
$81K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,132 |
1,696 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,228 |
3,175 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,193 |
1,171 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,054 |
1,019 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,731 |
1,702 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
439 |
288 |
$30K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
687 |
579 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,537 |
1,483 |
$27K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,449 |
1,118 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
117 |
104 |
$10K |
| 81025 |
|
1,341 |
1,081 |
$9K |
| 87210 |
|
1,775 |
1,442 |
$7K |
| 36415 |
Collection of venous blood by venipuncture |
2,543 |
2,053 |
$6K |
| 82120 |
|
1,773 |
1,444 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
293 |
227 |
$5K |
| 83986 |
|
1,613 |
1,322 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
328 |
182 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
15 |
15 |
$2K |
| 85018 |
|
702 |
536 |
$2K |
| D2160 |
|
15 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$1K |
| 90756 |
|
102 |
61 |
$1K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
26 |
24 |
$1K |
| 81003 |
|
463 |
257 |
$1K |
| 90686 |
|
73 |
67 |
$843.35 |
| D0240 |
|
41 |
41 |
$836.42 |
| 90734 |
|
499 |
415 |
$831.22 |
| 81002 |
|
217 |
143 |
$824.79 |
| 87081 |
|
133 |
106 |
$666.81 |
| 90715 |
|
197 |
163 |
$629.40 |
| 96127 |
|
94 |
75 |
$230.48 |
| 82950 |
|
13 |
13 |
$78.52 |
| 99000 |
|
4,670 |
3,665 |
$0.19 |
| 3008F |
|
168 |
136 |
$0.00 |
| 3078F |
|
20 |
14 |
$0.00 |