| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
1,021,016 |
874,020 |
$5.46M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,927 |
11,302 |
$1.74M |
| D0120 |
Periodic oral evaluation - established patient |
57,201 |
55,477 |
$1.66M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,911 |
10,108 |
$1.56M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12,527 |
9,968 |
$1.47M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,646 |
13,870 |
$1.27M |
| D1206 |
Topical application of fluoride varnish |
66,804 |
64,516 |
$1.16M |
| D1120 |
Prophylaxis - child |
37,726 |
36,470 |
$1.14M |
| D1351 |
Sealant - per tooth |
33,158 |
8,871 |
$1.02M |
| D1110 |
Prophylaxis - adult |
23,529 |
22,757 |
$999K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,842 |
10,929 |
$596K |
| D0274 |
Bitewings - four radiographic images |
14,905 |
14,403 |
$507K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,009 |
4,458 |
$471K |
| D0272 |
Bitewings - two radiographic images |
20,460 |
19,796 |
$405K |
| D0330 |
Panoramic radiographic image |
6,735 |
6,511 |
$391K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,431 |
3,720 |
$388K |
| D0220 |
Intraoral - periapical first radiographic image |
23,273 |
22,248 |
$386K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,589 |
7,263 |
$363K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,984 |
3,571 |
$362K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,314 |
2,924 |
$310K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,553 |
3,222 |
$301K |
| D0140 |
Limited oral evaluation - problem focused |
7,056 |
6,714 |
$276K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,621 |
1,146 |
$265K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
19,217 |
16,906 |
$263K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
10,462 |
9,324 |
$252K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,400 |
11,240 |
$182K |
| D4355 |
|
1,719 |
1,683 |
$132K |
| 99215 |
Prolong outpt/office vis |
817 |
517 |
$98K |
| D0240 |
|
5,146 |
2,765 |
$89K |
| D1354 |
|
10,154 |
3,892 |
$75K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
6,247 |
5,612 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
497 |
424 |
$65K |
| 96127 |
|
11,313 |
9,720 |
$62K |
| 0001A |
|
1,706 |
1,104 |
$56K |
| 99401 |
|
2,294 |
1,568 |
$53K |
| 90837 |
Psychotherapy, 53 minutes with patient |
689 |
325 |
$43K |
| 0002A |
|
1,404 |
860 |
$43K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
402 |
340 |
$43K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,240 |
1,033 |
$42K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
666 |
411 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,214 |
1,161 |
$38K |
| 90651 |
|
1,229 |
1,057 |
$22K |
| 96160 |
|
5,490 |
4,444 |
$18K |
| 90734 |
|
1,090 |
947 |
$16K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
271 |
238 |
$15K |
| D9995 |
|
169 |
162 |
$12K |
| 99501 |
|
200 |
182 |
$11K |
| 0071A |
|
249 |
162 |
$10K |
| 99460 |
|
247 |
132 |
$10K |
| 96161 |
|
2,739 |
2,400 |
$9K |
| T1002 |
Rn services, up to 15 minutes |
337 |
213 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
159 |
147 |
$9K |
| 0072A |
|
194 |
122 |
$8K |
| 92551 |
|
10,386 |
9,142 |
$8K |
| 90686 |
|
6,075 |
5,218 |
$8K |
| 90474 |
|
467 |
454 |
$7K |
| 99502 |
|
116 |
109 |
$7K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
175 |
103 |
$6K |
| 90715 |
|
1,240 |
979 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
274 |
148 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
32 |
29 |
$4K |
| 0004A |
|
103 |
60 |
$4K |
| 99173 |
|
12,700 |
11,013 |
$3K |
| 90619 |
|
1,110 |
835 |
$3K |
| 81025 |
|
345 |
323 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34 |
28 |
$3K |
| G9919 |
Screening performed and positive and provision of recommendations |
367 |
266 |
$2K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
13 |
12 |
$2K |
| 90716 |
|
76 |
51 |
$2K |
| 0053A |
|
34 |
26 |
$2K |
| D9996 |
|
3,150 |
3,076 |
$2K |
| 86592 |
|
303 |
287 |
$1K |
| 81003 |
|
547 |
414 |
$1K |
| 90473 |
|
104 |
99 |
$1K |
| 59025 |
Fetal non-stress test |
37 |
26 |
$1K |
| 0134A |
|
26 |
21 |
$1K |
| 0124A |
|
29 |
16 |
$971.00 |
| 85018 |
|
695 |
671 |
$881.93 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$834.35 |
| 92587 |
|
197 |
155 |
$828.30 |
| 97802 |
|
90 |
34 |
$778.01 |
| 82947 |
|
157 |
121 |
$742.45 |
| 90647 |
|
1,820 |
1,636 |
$606.32 |
| 90688 |
|
49 |
37 |
$600.12 |
| 90480 |
|
28 |
12 |
$585.00 |
| 90672 |
|
199 |
163 |
$524.72 |
| 90713 |
|
48 |
42 |
$517.68 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
79 |
75 |
$502.41 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
16 |
16 |
$366.08 |
| 90620 |
|
46 |
41 |
$350.20 |
| 90656 |
|
243 |
235 |
$312.82 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
237 |
212 |
$307.86 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
12 |
$279.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
19 |
19 |
$276.83 |
| 90633 |
|
1,081 |
980 |
$250.96 |
| 0011A |
|
20 |
17 |
$237.16 |
| 91300 |
|
3,038 |
1,856 |
$93.72 |
| 94760 |
|
223 |
123 |
$82.94 |
| 82950 |
|
12 |
12 |
$72.48 |
| 0012A |
|
45 |
20 |
$68.39 |
| 36415 |
Collection of venous blood by venipuncture |
635 |
543 |
$47.26 |
| 90670 |
|
2,935 |
2,632 |
$0.00 |
| ROARB |
|
2,713 |
2,673 |
$0.00 |
| 90681 |
|
322 |
307 |
$0.00 |
| 86703 |
|
69 |
68 |
$0.00 |
| 90685 |
|
201 |
198 |
$0.00 |
| 90710 |
|
742 |
664 |
$0.00 |
| 83655 |
|
200 |
197 |
$0.00 |
| 90707 |
|
23 |
13 |
$0.00 |
| 91312 |
|
29 |
16 |
$0.00 |
| 90671 |
|
468 |
440 |
$0.00 |
| 90700 |
|
48 |
43 |
$0.00 |
| 91313 |
|
26 |
21 |
$0.00 |
| D0350 |
|
69 |
69 |
$0.00 |
| 90723 |
|
1,910 |
1,725 |
$0.00 |
| WATER |
Water pressure mattress |
2,120 |
2,092 |
$0.00 |
| 90680 |
|
128 |
126 |
$0.00 |
| 36416 |
|
399 |
393 |
$0.00 |
| 90697 |
|
235 |
232 |
$0.00 |
| 91307 |
|
464 |
304 |
$0.00 |
| IMMUN |
Allergy/immunology ss |
46 |
46 |
$0.00 |
| 91301 |
|
97 |
63 |
$0.00 |
| 90696 |
|
130 |
111 |
$0.00 |
| 91305 |
|
99 |
71 |
$0.00 |
| 99000 |
|
302 |
221 |
$0.00 |