| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,784 |
5,083 |
$178K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,494 |
1,392 |
$56K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
468 |
454 |
$34K |
| 90832 |
Psychotherapy, 30 minutes with patient |
963 |
589 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
865 |
510 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
296 |
280 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
433 |
351 |
$18K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,273 |
1,976 |
$17K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
194 |
188 |
$11K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,074 |
924 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
140 |
138 |
$11K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
159 |
149 |
$10K |
| 87428 |
|
349 |
339 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
888 |
787 |
$10K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
122 |
114 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
700 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
84 |
79 |
$7K |
| D1110 |
Prophylaxis - adult |
706 |
640 |
$6K |
| D0274 |
Bitewings - four radiographic images |
641 |
624 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
148 |
$5K |
| D1206 |
Topical application of fluoride varnish |
1,212 |
1,114 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
655 |
625 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
130 |
$4K |
| D1330 |
|
1,209 |
1,102 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
130 |
$4K |
| D1120 |
Prophylaxis - child |
316 |
314 |
$4K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
263 |
249 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
113 |
105 |
$3K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
707 |
671 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
231 |
222 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
337 |
259 |
$2K |
| 90686 |
|
918 |
813 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,106 |
$1K |
| 99188 |
|
109 |
103 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
195 |
179 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
806 |
711 |
$955.00 |
| 90670 |
|
124 |
103 |
$900.25 |
| 99401 |
|
63 |
62 |
$750.11 |
| 90677 |
|
79 |
72 |
$727.55 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$554.39 |
| D0272 |
Bitewings - two radiographic images |
42 |
41 |
$419.38 |
| 36415 |
Collection of venous blood by venipuncture |
270 |
262 |
$376.64 |
| 81025 |
|
91 |
89 |
$221.43 |
| 85018 |
|
222 |
194 |
$210.40 |
| 90651 |
|
270 |
232 |
$197.52 |
| 3078F |
|
5,646 |
4,944 |
$136.30 |
| 3079F |
|
1,334 |
1,162 |
$126.69 |
| 90656 |
|
142 |
142 |
$116.33 |
| 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 |
36 |
28 |
$103.38 |
| 1159F |
|
6,567 |
5,789 |
$98.60 |
| 83026 |
|
38 |
36 |
$62.91 |
| D0603 |
|
731 |
697 |
$60.13 |
| 86703 |
|
55 |
47 |
$36.22 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$31.89 |
| 81002 |
|
12 |
12 |
$6.69 |
| D0602 |
|
51 |
51 |
$1.00 |
| 3351F |
|
911 |
797 |
$0.02 |
| 1033F |
|
930 |
793 |
$0.00 |
| 99173 |
|
611 |
543 |
$0.00 |
| 1160F |
|
6,646 |
5,818 |
$0.00 |
| 90461 |
|
151 |
138 |
$0.00 |
| 3210F |
|
405 |
331 |
$0.00 |
| 1158F |
|
237 |
214 |
$0.00 |
| 4004F |
|
335 |
292 |
$0.00 |
| 90734 |
|
121 |
103 |
$0.00 |
| 3077F |
|
98 |
77 |
$0.00 |
| 90633 |
|
73 |
69 |
$0.00 |
| 4035F |
|
53 |
51 |
$0.00 |
| 1126F |
|
2,423 |
2,206 |
$0.00 |
| 1036F |
|
1,510 |
1,280 |
$0.00 |
| 1125F |
|
725 |
649 |
$0.00 |
| 4000F |
|
521 |
467 |
$0.00 |
| 2001F |
|
10,595 |
8,909 |
$0.00 |
| 1000F |
|
6,597 |
5,374 |
$0.00 |
| 3044F |
|
553 |
501 |
$0.00 |
| 3008F |
|
9,671 |
8,187 |
$0.00 |
| 1220F |
|
2,338 |
2,094 |
$0.00 |
| 3074F |
|
6,277 |
5,575 |
$0.00 |
| 1034F |
|
431 |
372 |
$0.00 |
| 2000F |
|
6,483 |
5,654 |
$0.00 |
| 3075F |
|
689 |
644 |
$0.00 |
| 1030F |
|
556 |
508 |
$0.00 |
| 3080F |
|
53 |
40 |
$0.00 |
| 3353F |
|
128 |
97 |
$0.00 |
| 4037F |
|
53 |
51 |
$0.00 |
| 92551 |
|
587 |
527 |
$0.00 |
| 90647 |
|
95 |
83 |
$0.00 |
| 3352F |
|
194 |
158 |
$0.00 |
| 90620 |
|
36 |
33 |
$0.00 |
| 90723 |
|
92 |
84 |
$0.00 |
| 3014F |
|
17 |
13 |
$0.00 |
| 4010F |
|
46 |
39 |
$0.00 |
| 96127 |
|
35 |
35 |
$0.00 |
| 1157F |
|
42 |
36 |
$0.00 |
| 90674 |
|
40 |
34 |
$0.00 |