| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,383 |
686 |
$141K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,690 |
2,249 |
$135K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,483 |
2,438 |
$132K |
| D0330 |
Panoramic radiographic image |
1,941 |
1,544 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
974 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,332 |
1,027 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,291 |
1,196 |
$18K |
| 99215 |
Prolong outpt/office vis |
44 |
41 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
116 |
103 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
2,392 |
2,005 |
$4K |
| 90688 |
|
213 |
189 |
$3K |
| D1110 |
Prophylaxis - adult |
100 |
96 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
253 |
214 |
$3K |
| 81003 |
|
1,677 |
1,095 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
12 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
167 |
131 |
$2K |
| D1206 |
Topical application of fluoride varnish |
183 |
157 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
159 |
143 |
$798.95 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
328 |
270 |
$654.68 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$566.54 |
| 99000 |
|
288 |
223 |
$527.22 |
| 80053 |
Comprehensive metabolic panel |
515 |
456 |
$467.81 |
| 80061 |
Lipid panel |
182 |
159 |
$385.39 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$361.77 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
117 |
104 |
$325.57 |
| D7311 |
|
24 |
12 |
$245.40 |
| 90734 |
|
14 |
14 |
$218.00 |
| 99406 |
|
35 |
24 |
$174.84 |
| 84443 |
Thyroid stimulating hormone (TSH) |
46 |
38 |
$122.64 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
32 |
31 |
$68.00 |
| 96160 |
|
25 |
24 |
$50.59 |
| S9452 |
Nutrition classes, non-physician provider, per session |
14 |
12 |
$40.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
46 |
38 |
$29.60 |
| A6413 |
Adhesive bandage, first-aid type, any size, each |
274 |
199 |
$13.86 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
76 |
70 |
$1.15 |
| D1330 |
|
55 |
44 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |