| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
14,267 |
10,029 |
$3.75M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,863 |
7,165 |
$1.89M |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,866 |
1,654 |
$429K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,635 |
1,436 |
$369K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,981 |
1,720 |
$342K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,495 |
1,289 |
$338K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,694 |
1,295 |
$311K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,029 |
863 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,417 |
900 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
3,379 |
2,917 |
$16K |
| D1206 |
Topical application of fluoride varnish |
3,446 |
2,968 |
$15K |
| D1110 |
Prophylaxis - adult |
2,396 |
2,089 |
$14K |
| D1120 |
Prophylaxis - child |
1,388 |
1,177 |
$14K |
| 90651 |
|
316 |
283 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,703 |
1,413 |
$12K |
| 90670 |
|
1,015 |
864 |
$10K |
| 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 |
218 |
189 |
$7K |
| D0330 |
Panoramic radiographic image |
622 |
492 |
$7K |
| 99381 |
|
22 |
16 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
768 |
465 |
$5K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
727 |
510 |
$5K |
| D1351 |
Sealant - per tooth |
655 |
181 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
168 |
99 |
$4K |
| 90680 |
|
747 |
645 |
$4K |
| 90710 |
|
140 |
128 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
2,423 |
2,103 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
22 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
711 |
421 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
977 |
817 |
$3K |
| 90697 |
|
436 |
419 |
$2K |
| 90633 |
|
662 |
545 |
$2K |
| 94010 |
|
77 |
56 |
$2K |
| 90686 |
|
1,369 |
1,277 |
$2K |
| 90620 |
|
33 |
29 |
$2K |
| 90734 |
|
113 |
86 |
$1K |
| 90723 |
|
347 |
265 |
$1K |
| 99177 |
|
1,748 |
1,542 |
$1K |
| 90619 |
|
93 |
88 |
$1K |
| 90671 |
|
252 |
247 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
189 |
$903.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,985 |
1,710 |
$870.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
49 |
$840.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
669 |
606 |
$647.92 |
| 90647 |
|
372 |
281 |
$641.24 |
| 90688 |
|
308 |
266 |
$639.85 |
| 99173 |
|
1,824 |
1,568 |
$569.66 |
| 90696 |
|
77 |
73 |
$548.29 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
495 |
444 |
$509.96 |
| 90461 |
|
17 |
14 |
$482.82 |
| 90687 |
|
592 |
491 |
$373.54 |
| 90715 |
|
89 |
84 |
$316.96 |
| 36415 |
Collection of venous blood by venipuncture |
365 |
339 |
$244.41 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
825 |
708 |
$241.41 |
| 95012 |
|
89 |
65 |
$231.81 |
| 92551 |
|
234 |
211 |
$215.02 |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
53 |
$204.00 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
123 |
70 |
$122.80 |
| 81002 |
|
228 |
182 |
$37.53 |
| 90672 |
|
22 |
18 |
$28.29 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
98 |
39 |
$16.42 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
138 |
125 |
$13.60 |
| 85018 |
|
83 |
65 |
$9.96 |
| 90707 |
|
15 |
15 |
$0.00 |
| 90700 |
|
13 |
13 |
$0.00 |
| 83655 |
|
16 |
16 |
$0.00 |
| 36416 |
|
313 |
263 |
$0.00 |
| 88720 |
|
134 |
70 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
47 |
40 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
116 |
113 |
$0.00 |
| 92567 |
|
36 |
15 |
$0.00 |
| 90716 |
|
16 |
15 |
$0.00 |
| 93000 |
|
13 |
12 |
$0.00 |