| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,755 |
12,149 |
$376K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,397 |
1,844 |
$135K |
| H1000 |
Prenatal care, at-risk assessment |
3,818 |
2,135 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,022 |
1,515 |
$115K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,039 |
1,592 |
$111K |
| D0330 |
Panoramic radiographic image |
1,609 |
1,567 |
$83K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,234 |
927 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,736 |
2,603 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,894 |
1,404 |
$64K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,368 |
1,186 |
$58K |
| D1120 |
Prophylaxis - child |
2,547 |
2,460 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
2,224 |
1,946 |
$39K |
| D1110 |
Prophylaxis - adult |
1,168 |
1,135 |
$36K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
448 |
420 |
$31K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,318 |
2,390 |
$30K |
| D1351 |
Sealant - per tooth |
2,451 |
875 |
$29K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,471 |
979 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,931 |
1,893 |
$22K |
| D1206 |
Topical application of fluoride varnish |
4,719 |
4,551 |
$22K |
| D1330 |
|
4,904 |
4,716 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
500 |
382 |
$15K |
| 90832 |
Psychotherapy, 30 minutes with patient |
343 |
189 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
1,299 |
1,194 |
$12K |
| 90671 |
|
322 |
287 |
$12K |
| 99381 |
|
160 |
118 |
$10K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
147 |
131 |
$10K |
| D1354 |
|
1,332 |
290 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
213 |
211 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
127 |
107 |
$6K |
| 90670 |
|
798 |
577 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,930 |
3,687 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,096 |
1,808 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,534 |
1,512 |
$4K |
| D0190 |
|
5,201 |
4,920 |
$4K |
| 90461 |
|
2,066 |
1,253 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,327 |
1,142 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,620 |
4,331 |
$4K |
| 99383 |
|
47 |
42 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
44 |
40 |
$3K |
| 90677 |
|
14 |
14 |
$3K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
70 |
64 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$3K |
| 81025 |
|
1,580 |
1,166 |
$3K |
| 90686 |
|
561 |
522 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
200 |
72 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
27 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
98 |
98 |
$2K |
| 90661 |
|
105 |
103 |
$2K |
| 59430 |
|
49 |
32 |
$1K |
| 82962 |
|
3,575 |
2,601 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
2,170 |
1,718 |
$1K |
| D3120 |
|
318 |
293 |
$1K |
| 81002 |
|
2,038 |
1,383 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
467 |
374 |
$1K |
| 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 |
1,452 |
1,049 |
$1K |
| 90710 |
|
161 |
144 |
$1K |
| 90647 |
|
366 |
303 |
$988.90 |
| D0191 |
|
580 |
558 |
$919.20 |
| 83655 |
|
152 |
147 |
$738.34 |
| D0603 |
|
3,109 |
2,965 |
$643.00 |
| 90651 |
|
217 |
188 |
$620.10 |
| 3074F |
|
9,749 |
7,893 |
$600.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
247 |
87 |
$478.37 |
| 85018 |
|
540 |
508 |
$384.39 |
| 90697 |
|
172 |
152 |
$313.18 |
| 3078F |
|
8,802 |
6,780 |
$302.76 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
46 |
$286.64 |
| D0602 |
|
1,004 |
941 |
$243.00 |
| 90734 |
|
69 |
66 |
$219.00 |
| 90633 |
|
324 |
219 |
$209.00 |
| D0601 |
|
1,203 |
1,163 |
$177.00 |
| 90723 |
|
183 |
125 |
$163.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
74 |
50 |
$147.77 |
| D9995 |
|
28 |
28 |
$140.91 |
| 90474 |
|
43 |
37 |
$100.00 |
| 99188 |
|
90 |
83 |
$76.41 |
| 3075F |
|
572 |
451 |
$75.00 |
| 3008F |
|
13,469 |
10,792 |
$71.87 |
| 90715 |
|
13 |
12 |
$66.39 |
| 99408 |
|
12 |
12 |
$51.72 |
| 81003 |
|
981 |
567 |
$43.71 |
| 90685 |
|
23 |
17 |
$40.00 |
| 2000F |
|
13,942 |
10,669 |
$35.38 |
| 36416 |
|
1,254 |
974 |
$28.04 |
| 4037F |
|
280 |
265 |
$24.00 |
| 1160F |
|
13,392 |
10,816 |
$16.69 |
| 2001F |
|
19,432 |
15,187 |
$13.45 |
| D0270 |
|
48 |
45 |
$8.96 |
| 96127 |
|
332 |
308 |
$8.46 |
| 1159F |
|
13,393 |
10,794 |
$6.69 |
| 1000F |
|
7,980 |
6,603 |
$2.14 |
| 2010F |
|
8,195 |
6,795 |
$0.00 |
| 1220F |
|
5,155 |
4,560 |
$0.00 |
| 1036F |
|
1,579 |
1,360 |
$0.00 |
| 3044F |
|
769 |
676 |
$0.00 |
| 1125F |
|
743 |
682 |
$0.00 |
| 99000 |
|
241 |
138 |
$0.00 |
| 3080F |
|
160 |
118 |
$0.00 |
| 4000F |
|
5,019 |
4,426 |
$0.00 |
| D1310 |
|
3,573 |
3,364 |
$0.00 |
| 1126F |
|
4,932 |
4,231 |
$0.00 |
| 1055F |
|
545 |
500 |
$0.00 |
| 4010F |
|
100 |
71 |
$0.00 |
| 3351F |
|
206 |
197 |
$0.00 |
| 3079F |
|
2,152 |
1,700 |
$0.00 |
| 1157F |
|
350 |
110 |
$0.00 |
| 92551 |
|
473 |
399 |
$0.00 |
| 3353F |
|
30 |
26 |
$0.00 |
| 1034F |
|
12 |
12 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
33 |
33 |
$0.00 |
| 90674 |
|
37 |
17 |
$0.00 |
| 90696 |
|
16 |
16 |
$0.00 |
| 4060F |
|
64 |
48 |
$0.00 |
| 2028F |
|
2,132 |
1,802 |
$0.00 |
| 99173 |
|
845 |
657 |
$0.00 |
| 3077F |
|
430 |
315 |
$0.00 |
| 90681 |
|
151 |
131 |
$0.00 |
| 4035F |
|
102 |
98 |
$0.00 |
| 11721 |
|
26 |
26 |
$0.00 |
| 90756 |
|
12 |
12 |
$0.00 |
| 99177 |
|
16 |
15 |
$0.00 |
| 90700 |
|
14 |
12 |
$0.00 |