| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,334 |
14,526 |
$2.86M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,264 |
5,683 |
$878K |
| D1206 |
Topical application of fluoride varnish |
6,720 |
6,554 |
$675K |
| D1120 |
Prophylaxis - child |
2,176 |
2,120 |
$324K |
| D1110 |
Prophylaxis - adult |
1,397 |
1,350 |
$214K |
| D0330 |
Panoramic radiographic image |
641 |
614 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
783 |
751 |
$89K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,530 |
1,468 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
328 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
630 |
610 |
$47K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
217 |
215 |
$46K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
221 |
214 |
$42K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
333 |
314 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
434 |
252 |
$42K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
134 |
134 |
$31K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
374 |
362 |
$25K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
130 |
125 |
$23K |
| D0274 |
Bitewings - four radiographic images |
974 |
927 |
$23K |
| D1351 |
Sealant - per tooth |
2,206 |
512 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
125 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,179 |
1,119 |
$13K |
| 90834 |
Psychotherapy, 45 minutes with patient |
68 |
39 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
74 |
72 |
$9K |
| D1354 |
|
401 |
148 |
$6K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
420 |
418 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
374 |
165 |
$5K |
| 99173 |
|
290 |
281 |
$5K |
| 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 |
5,056 |
3,611 |
$5K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
484 |
276 |
$5K |
| 99384 |
|
21 |
21 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,558 |
1,483 |
$3K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
85 |
79 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
13 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| 87634 |
|
15 |
15 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
74 |
67 |
$788.51 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,178 |
1,142 |
$730.45 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
137 |
133 |
$720.64 |
| D0272 |
Bitewings - two radiographic images |
193 |
190 |
$680.24 |
| 87807 |
|
64 |
62 |
$629.87 |
| 90686 |
|
371 |
360 |
$570.05 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
85 |
79 |
$381.38 |
| 90651 |
|
55 |
54 |
$333.40 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
401 |
389 |
$131.69 |
| 81025 |
|
26 |
25 |
$128.11 |
| 81003 |
|
111 |
106 |
$113.36 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
296 |
275 |
$60.00 |
| 3078F |
|
321 |
268 |
$0.00 |
| D0191 |
|
430 |
427 |
$0.00 |
| 90715 |
|
13 |
13 |
$0.00 |
| D2941 |
|
39 |
12 |
$0.00 |
| 90734 |
|
28 |
26 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
18 |
$0.00 |
| D0270 |
|
51 |
51 |
$0.00 |
| 90633 |
|
14 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,850 |
729 |
$0.00 |
| 3074F |
|
89 |
75 |
$0.00 |
| D0603 |
|
602 |
598 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
655 |
598 |
$0.00 |
| 3075F |
|
15 |
15 |
$0.00 |
| 3079F |
|
110 |
101 |
$0.00 |
| 90656 |
|
28 |
28 |
$0.00 |
| 90647 |
|
24 |
24 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 94760 |
|
26 |
21 |
$0.00 |
| D1330 |
|
29 |
29 |
$0.00 |