| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
40,577 |
40,552 |
$1.73M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,664 |
4,816 |
$1.72M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28,203 |
25,568 |
$1.71M |
| D1206 |
Topical application of fluoride varnish |
53,602 |
53,530 |
$1.52M |
| D0120 |
Periodic oral evaluation - established patient |
40,220 |
40,199 |
$1.39M |
| 90834 |
Psychotherapy, 45 minutes with patient |
14,793 |
11,343 |
$797K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
8,960 |
8,828 |
$743K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,974 |
5,008 |
$733K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,311 |
4,295 |
$671K |
| D1351 |
Sealant - per tooth |
20,578 |
8,348 |
$639K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,975 |
6,611 |
$596K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
6,914 |
6,850 |
$574K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,560 |
4,518 |
$537K |
| D1110 |
Prophylaxis - adult |
8,677 |
8,672 |
$466K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
6,560 |
6,379 |
$445K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
8,956 |
3,535 |
$405K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,649 |
6,640 |
$404K |
| D0272 |
Bitewings - two radiographic images |
16,264 |
16,253 |
$374K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,076 |
3,157 |
$373K |
| D0274 |
Bitewings - four radiographic images |
9,132 |
9,124 |
$326K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15,329 |
15,103 |
$311K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
6,599 |
2,233 |
$279K |
| D0140 |
Limited oral evaluation - problem focused |
4,420 |
4,346 |
$274K |
| D2140 |
|
3,653 |
2,968 |
$264K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,990 |
2,940 |
$255K |
| 90832 |
Psychotherapy, 30 minutes with patient |
6,608 |
5,698 |
$253K |
| D0220 |
Intraoral - periapical first radiographic image |
12,527 |
12,260 |
$239K |
| D0210 |
Intraoral - complete series of radiographic images |
2,885 |
2,791 |
$189K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,280 |
4,279 |
$180K |
| 92523 |
|
1,351 |
1,321 |
$179K |
| D0191 |
|
7,909 |
7,903 |
$173K |
| 90837 |
Psychotherapy, 53 minutes with patient |
2,094 |
1,734 |
$158K |
| 99381 |
|
1,843 |
1,824 |
$157K |
| D2330 |
|
1,829 |
1,222 |
$155K |
| D0330 |
Panoramic radiographic image |
2,070 |
2,070 |
$146K |
| D1354 |
|
5,633 |
2,130 |
$143K |
| D2331 |
|
926 |
657 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,391 |
3,514 |
$85K |
| 92551 |
|
12,013 |
11,829 |
$84K |
| 90671 |
|
649 |
613 |
$82K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,742 |
1,695 |
$71K |
| 99382 |
|
678 |
655 |
$63K |
| D9920 |
|
1,021 |
1,006 |
$58K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,002 |
985 |
$47K |
| 83655 |
|
3,500 |
3,420 |
$43K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,419 |
1,366 |
$42K |
| 99383 |
|
416 |
402 |
$38K |
| 99384 |
|
358 |
341 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
280 |
226 |
$35K |
| D9248 |
|
502 |
490 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
205 |
$32K |
| 92579 |
|
1,137 |
1,123 |
$30K |
| 92586 |
|
590 |
586 |
$30K |
| 92526 |
|
567 |
231 |
$30K |
| 99174 |
|
11,771 |
11,602 |
$26K |
| D1352 |
|
458 |
380 |
$26K |
| D2940 |
|
376 |
294 |
$26K |
| 92567 |
|
2,734 |
2,711 |
$25K |
| 97162 |
|
416 |
415 |
$25K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
207 |
205 |
$24K |
| 96127 |
|
7,059 |
6,922 |
$21K |
| 92582 |
|
407 |
406 |
$20K |
| 36416 |
|
3,431 |
3,321 |
$20K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
1,374 |
1,344 |
$19K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,663 |
1,632 |
$18K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
329 |
323 |
$16K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
492 |
174 |
$16K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
186 |
185 |
$14K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
925 |
697 |
$14K |
| 87634 |
|
572 |
553 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
535 |
532 |
$12K |
| 36415 |
Collection of venous blood by venipuncture |
2,870 |
2,758 |
$11K |
| D9420 |
|
52 |
52 |
$9K |
| D1510 |
|
44 |
38 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,193 |
1,151 |
$9K |
| D7111 |
|
112 |
86 |
$8K |
| 85018 |
|
4,262 |
4,174 |
$7K |
| 92609 |
|
110 |
50 |
$7K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
872 |
818 |
$7K |
| 92650 |
|
406 |
406 |
$7K |
| 96161 |
|
3,659 |
3,565 |
$6K |
| 94010 |
|
279 |
278 |
$5K |
| D2160 |
|
45 |
42 |
$5K |
| 0071A |
|
126 |
126 |
$5K |
| 69210 |
|
179 |
172 |
$5K |
| D0273 |
|
191 |
190 |
$5K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
138 |
58 |
$5K |
| D2390 |
|
23 |
12 |
$5K |
| 0072A |
|
114 |
113 |
$4K |
| D0240 |
|
184 |
165 |
$4K |
| 0001A |
|
98 |
98 |
$4K |
| D2332 |
|
28 |
24 |
$4K |
| D2335 |
|
27 |
24 |
$4K |
| 97165 |
|
50 |
50 |
$3K |
| 92651 |
|
62 |
62 |
$3K |
| 0002A |
|
80 |
80 |
$3K |
| 81002 |
|
1,153 |
1,098 |
$3K |
| 93000 |
|
321 |
317 |
$3K |
| D0270 |
|
225 |
224 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
216 |
210 |
$2K |
| 99441 |
|
251 |
215 |
$2K |
| 86804 |
|
297 |
290 |
$2K |
| 81025 |
|
265 |
256 |
$2K |
| 92587 |
|
142 |
142 |
$2K |
| 92557 |
|
70 |
70 |
$2K |
| 97166 |
|
28 |
28 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
130 |
125 |
$1K |
| 99495 |
|
13 |
13 |
$1K |
| 90785 |
|
151 |
123 |
$1K |
| 87807 |
|
150 |
143 |
$1K |
| 99188 |
|
112 |
109 |
$816.09 |
| 99442 |
|
55 |
49 |
$798.81 |
| 92610 |
|
14 |
14 |
$741.50 |
| 87430 |
|
146 |
130 |
$679.60 |
| 98966 |
|
239 |
236 |
$640.62 |
| 90686 |
|
3,083 |
2,998 |
$238.64 |
| 98967 |
|
40 |
39 |
$225.75 |
| 90716 |
|
3,460 |
3,370 |
$204.51 |
| 90656 |
|
223 |
222 |
$110.16 |
| 90733 |
|
21 |
19 |
$106.49 |
| 88720 |
|
24 |
24 |
$38.00 |
| 90707 |
|
3,435 |
3,345 |
$37.00 |
| 97802 |
|
57 |
56 |
$20.00 |
| 90461 |
|
10,904 |
10,750 |
$14.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
8,471 |
8,100 |
$0.63 |
| G9007 |
Coordinated care fee, scheduled team conference |
687 |
669 |
$0.35 |
| G9002 |
Coordinated care fee, maintenance rate |
576 |
563 |
$0.24 |
| 2000F |
|
165 |
163 |
$0.06 |
| A9150 |
Non-prescription drugs |
541 |
524 |
$0.01 |
| 90670 |
|
5,065 |
4,953 |
$0.00 |
| 90685 |
|
321 |
312 |
$0.00 |
| 90633 |
|
3,543 |
3,452 |
$0.00 |
| 90700 |
|
1,581 |
1,546 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
3,405 |
3,261 |
$0.00 |
| G8484 |
Influenza immunization was not administered, reason not given |
1,659 |
1,546 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
442 |
415 |
$0.00 |
| 90715 |
|
1,010 |
981 |
$0.00 |
| 90734 |
|
982 |
954 |
$0.00 |
| 91300 |
|
124 |
117 |
$0.00 |
| 99173 |
|
28 |
28 |
$0.00 |
| D9996 |
|
75 |
71 |
$0.00 |
| 98968 |
|
13 |
13 |
$0.00 |
| 90846 |
Family psychotherapy without the patient present, 50 minutes |
27 |
26 |
$0.00 |
| D9986 |
|
80 |
79 |
$0.00 |
| G9905 |
Patient not screened for tobacco use |
47 |
46 |
$0.00 |
| D0251 |
|
68 |
68 |
$0.00 |
| 90680 |
|
3,428 |
3,340 |
$0.00 |
| D3120 |
|
63 |
37 |
$0.00 |
| 90619 |
|
593 |
560 |
$0.00 |
| 1036F |
|
209 |
204 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,809 |
1,775 |
$0.00 |
| 90723 |
|
4,650 |
4,538 |
$0.00 |
| G8432 |
Depression screening not documented, reason not given |
446 |
422 |
$0.00 |
| 90620 |
|
239 |
224 |
$0.00 |
| 90647 |
|
4,565 |
4,444 |
$0.00 |
| 90651 |
|
1,561 |
1,503 |
$0.00 |
| 91307 |
|
238 |
224 |
$0.00 |
| 90696 |
|
1,238 |
1,210 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
130 |
126 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |
| D1353 |
|
791 |
461 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
26 |
25 |
$0.00 |
| J7609 |
Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg |
40 |
38 |
$0.00 |
| D0250 |
|
12 |
12 |
$0.00 |
| 90688 |
|
69 |
68 |
$0.00 |
| 90381 |
|
21 |
21 |
$0.00 |