| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,768 |
2,549 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,257 |
1,245 |
$39K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
249 |
249 |
$18K |
| D1110 |
Prophylaxis - adult |
331 |
325 |
$17K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
194 |
191 |
$14K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
188 |
183 |
$13K |
| D0330 |
Panoramic radiographic image |
261 |
258 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
424 |
397 |
$12K |
| D1330 |
|
1,139 |
1,124 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
155 |
152 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
186 |
149 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,075 |
1,061 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
134 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
314 |
312 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,080 |
1,063 |
$4K |
| D1351 |
Sealant - per tooth |
622 |
145 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
385 |
377 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
491 |
485 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
90 |
83 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
58 |
55 |
$3K |
| D1120 |
Prophylaxis - child |
594 |
590 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
431 |
417 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,005 |
1,950 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,588 |
1,484 |
$2K |
| 99385 |
|
28 |
28 |
$2K |
| 99188 |
|
203 |
201 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
74 |
74 |
$2K |
| D1999 |
|
19 |
19 |
$1K |
| D0272 |
Bitewings - two radiographic images |
182 |
182 |
$785.41 |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$683.81 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$602.25 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$528.00 |
| D0602 |
|
17 |
17 |
$260.40 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
27 |
27 |
$179.24 |
| 99441 |
|
78 |
71 |
$177.14 |
| 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 |
333 |
251 |
$173.09 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
145 |
138 |
$166.32 |
| D9310 |
|
209 |
206 |
$135.75 |
| 90474 |
|
18 |
18 |
$130.00 |
| 36415 |
Collection of venous blood by venipuncture |
498 |
457 |
$82.19 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$69.79 |
| 81025 |
|
12 |
12 |
$42.24 |
| 1036F |
|
935 |
740 |
$33.57 |
| 92551 |
|
881 |
715 |
$27.48 |
| 85018 |
|
32 |
30 |
$25.28 |
| 3725F |
|
1,960 |
1,524 |
$0.00 |
| 99173 |
|
872 |
704 |
$0.00 |
| 3077F |
|
154 |
132 |
$0.00 |
| 3078F |
|
640 |
531 |
$0.00 |
| 90648 |
|
23 |
23 |
$0.00 |
| 90670 |
|
101 |
99 |
$0.00 |
| 1159F |
|
285 |
268 |
$0.00 |
| 90734 |
|
70 |
70 |
$0.00 |
| 90633 |
|
25 |
24 |
$0.00 |
| 90681 |
|
17 |
17 |
$0.00 |
| 1160F |
|
20 |
20 |
$0.00 |
| 3008F |
|
4,849 |
3,819 |
$0.00 |
| 3074F |
|
678 |
648 |
$0.00 |
| 96127 |
|
421 |
256 |
$0.00 |
| 3079F |
|
358 |
302 |
$0.00 |
| 90651 |
|
56 |
56 |
$0.00 |
| 1126F |
|
258 |
244 |
$0.00 |
| 3080F |
|
42 |
32 |
$0.00 |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
134 |
129 |
$0.00 |
| 3075F |
|
96 |
95 |
$0.00 |
| 1125F |
|
151 |
143 |
$0.00 |
| 1034F |
|
57 |
44 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
18 |
18 |
$0.00 |
| 90697 |
|
16 |
16 |
$0.00 |
| 90723 |
|
20 |
20 |
$0.00 |