| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
8,866 |
7,986 |
$714K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13,378 |
12,419 |
$622K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,357 |
4,137 |
$317K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,827 |
5,356 |
$198K |
| 99381 |
|
1,036 |
991 |
$112K |
| D1120 |
Prophylaxis - child |
4,467 |
4,396 |
$84K |
| D0603 |
|
2,713 |
2,674 |
$79K |
| D0602 |
|
2,459 |
2,432 |
$76K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16,600 |
15,521 |
$51K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
9,854 |
8,861 |
$47K |
| D1110 |
Prophylaxis - adult |
662 |
658 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
3,980 |
3,940 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
411 |
$19K |
| D1206 |
Topical application of fluoride varnish |
5,529 |
5,438 |
$17K |
| 99385 |
|
174 |
156 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
244 |
224 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
515 |
464 |
$14K |
| D1354 |
|
4,364 |
823 |
$14K |
| 90686 |
|
5,830 |
5,548 |
$12K |
| D1330 |
|
6,905 |
5,818 |
$12K |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
259 |
190 |
$11K |
| 90670 |
|
4,214 |
3,881 |
$10K |
| 90723 |
|
713 |
659 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,130 |
2,329 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
421 |
417 |
$8K |
| D1351 |
Sealant - per tooth |
912 |
461 |
$7K |
| 99442 |
|
353 |
319 |
$6K |
| D0330 |
Panoramic radiographic image |
128 |
126 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
27 |
$5K |
| 90698 |
|
1,162 |
1,073 |
$4K |
| 90474 |
|
2,215 |
2,107 |
$4K |
| 99443 |
|
255 |
178 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,557 |
1,545 |
$3K |
| 90681 |
|
2,419 |
2,258 |
$3K |
| 90648 |
|
1,141 |
1,069 |
$3K |
| 90633 |
|
1,969 |
1,855 |
$3K |
| D0190 |
|
581 |
577 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,798 |
2,710 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,252 |
1,242 |
$2K |
| 90685 |
|
592 |
533 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
31 |
27 |
$2K |
| 90744 |
|
457 |
416 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
16 |
14 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
14 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
489 |
418 |
$1K |
| 99441 |
|
103 |
99 |
$973.88 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
12 |
$942.60 |
| H1000 |
Prenatal care, at-risk assessment |
17 |
12 |
$910.68 |
| 82948 |
|
802 |
694 |
$762.75 |
| 90707 |
|
192 |
185 |
$649.98 |
| 90688 |
|
123 |
110 |
$370.00 |
| 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 |
31 |
24 |
$369.96 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$300.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
86 |
62 |
$142.77 |
| 90700 |
|
129 |
126 |
$120.00 |
| 90716 |
|
261 |
252 |
$110.00 |
| 90671 |
|
1,379 |
1,353 |
$109.51 |
| 3044F |
|
408 |
389 |
$60.00 |
| D1310 |
|
6,093 |
5,018 |
$50.54 |
| 90710 |
|
12 |
12 |
$50.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
30 |
26 |
$46.95 |
| 90651 |
|
14 |
14 |
$30.00 |
| 3008F |
|
10,054 |
8,430 |
$10.55 |
| D0601 |
|
28 |
28 |
$8.00 |
| 3351F |
|
7,093 |
5,753 |
$0.00 |
| 90697 |
|
1,357 |
1,276 |
$0.00 |
| 3074F |
|
3,727 |
3,510 |
$0.00 |
| 1126F |
|
162 |
147 |
$0.00 |
| 1170F |
|
471 |
440 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
29 |
28 |
$0.00 |
| 3079F |
|
1,136 |
997 |
$0.00 |
| 90656 |
|
212 |
211 |
$0.00 |
| 3075F |
|
282 |
268 |
$0.00 |
| 92551 |
|
28 |
28 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
24 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
144 |
122 |
$0.00 |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
15 |
13 |
$0.00 |
| 96156 |
|
58 |
46 |
$0.00 |
| 90674 |
|
146 |
142 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$0.00 |
| 1220F |
|
19 |
18 |
$0.00 |
| 1125F |
|
16 |
13 |
$0.00 |
| 91311 |
|
147 |
132 |
$0.00 |
| 1160F |
|
994 |
973 |
$0.00 |
| D9993 |
|
5,242 |
5,167 |
$0.00 |
| 3078F |
|
4,125 |
3,455 |
$0.00 |
| 3725F |
|
9,050 |
7,464 |
$0.00 |
| 1159F |
|
1,040 |
1,017 |
$0.00 |
| 80354 |
|
43 |
37 |
$0.00 |
| 80305 |
|
31 |
25 |
$0.00 |
| 3077F |
|
61 |
49 |
$0.00 |
| 3288F |
|
57 |
50 |
$0.00 |
| 99173 |
|
42 |
41 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
31 |
27 |
$0.00 |
| 81002 |
|
22 |
17 |
$0.00 |
| 90649 |
|
27 |
26 |
$0.00 |