| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,093 |
3,825 |
$317K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,640 |
5,033 |
$317K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,331 |
4,090 |
$126K |
| D0274 |
Bitewings - four radiographic images |
2,257 |
2,013 |
$71K |
| T1015 |
Clinic visit/encounter, all-inclusive |
8,006 |
6,129 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,488 |
1,294 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
704 |
432 |
$55K |
| 99401 |
|
2,608 |
2,026 |
$50K |
| D1110 |
Prophylaxis - adult |
1,176 |
1,029 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,455 |
1,310 |
$43K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
443 |
355 |
$34K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
354 |
269 |
$25K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,183 |
2,615 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,121 |
967 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,735 |
1,515 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
228 |
$20K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,305 |
1,058 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
133 |
111 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,163 |
786 |
$10K |
| 90651 |
|
232 |
171 |
$8K |
| 90686 |
|
763 |
642 |
$6K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
84 |
71 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
128 |
85 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
34 |
31 |
$4K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
52 |
30 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
1,635 |
1,381 |
$3K |
| 96127 |
|
1,033 |
528 |
$3K |
| 0001A |
|
71 |
61 |
$2K |
| 99383 |
|
34 |
34 |
$2K |
| D1206 |
Topical application of fluoride varnish |
69 |
67 |
$2K |
| 0002A |
|
45 |
42 |
$1K |
| 90674 |
|
58 |
56 |
$1K |
| 99384 |
|
15 |
13 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
19 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
16 |
$1K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
37 |
28 |
$886.62 |
| 0071A |
|
54 |
25 |
$855.83 |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
59 |
$714.50 |
| 90688 |
|
38 |
36 |
$489.54 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
77 |
66 |
$454.67 |
| 90670 |
|
55 |
50 |
$397.25 |
| 0124A |
|
24 |
14 |
$332.10 |
| 81025 |
|
36 |
14 |
$259.06 |
| 90685 |
|
98 |
65 |
$248.57 |
| 90633 |
|
86 |
68 |
$33.76 |
| 99173 |
|
18 |
13 |
$24.70 |
| 90744 |
|
14 |
12 |
$0.01 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
13 |
$0.00 |
| 3077F |
|
59 |
43 |
$0.00 |
| 90715 |
|
14 |
12 |
$0.00 |
| 90734 |
|
32 |
25 |
$0.00 |
| 3078F |
|
13 |
12 |
$0.00 |
| 3008F |
|
970 |
875 |
$0.00 |
| 3352F |
|
59 |
47 |
$0.00 |
| 91307 |
|
37 |
31 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
35 |
33 |
$0.00 |
| 3074F |
|
29 |
24 |
$0.00 |
| 3079F |
|
30 |
26 |
$0.00 |