| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,350 |
15,053 |
$2.66M |
| D1206 |
Topical application of fluoride varnish |
7,106 |
6,840 |
$572K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,509 |
3,143 |
$505K |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,308 |
2,139 |
$437K |
| D1120 |
Prophylaxis - child |
2,503 |
2,442 |
$266K |
| D1110 |
Prophylaxis - adult |
1,093 |
1,044 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
1,011 |
930 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,158 |
591 |
$91K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
380 |
370 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
585 |
409 |
$57K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
297 |
294 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
836 |
778 |
$49K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,031 |
638 |
$45K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
226 |
222 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
592 |
362 |
$39K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,022 |
979 |
$34K |
| D0330 |
Panoramic radiographic image |
201 |
200 |
$27K |
| D1351 |
Sealant - per tooth |
3,393 |
800 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
968 |
944 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
110 |
$19K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
129 |
122 |
$16K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
93 |
87 |
$15K |
| D0274 |
Bitewings - four radiographic images |
334 |
326 |
$10K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
111 |
111 |
$9K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
39 |
38 |
$9K |
| D0272 |
Bitewings - two radiographic images |
453 |
448 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
597 |
534 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,501 |
1,435 |
$4K |
| 92551 |
|
479 |
473 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,272 |
1,134 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
269 |
182 |
$3K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
229 |
227 |
$3K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
141 |
135 |
$3K |
| 99173 |
|
555 |
540 |
$3K |
| 99383 |
|
21 |
17 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$2K |
| 99384 |
|
13 |
13 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
369 |
363 |
$2K |
| 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 |
2,828 |
2,136 |
$2K |
| 90686 |
|
473 |
446 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
615 |
307 |
$1K |
| D1354 |
|
621 |
202 |
$991.86 |
| 36415 |
Collection of venous blood by venipuncture |
944 |
878 |
$531.27 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
474 |
464 |
$393.65 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$216.65 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
155 |
104 |
$164.30 |
| D0270 |
|
49 |
48 |
$59.36 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
12 |
12 |
$15.00 |
| 85018 |
|
13 |
13 |
$11.76 |
| 94760 |
|
217 |
140 |
$0.00 |
| 3079F |
|
58 |
53 |
$0.00 |
| 90656 |
|
62 |
62 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |
| D9995 |
|
13 |
13 |
$0.00 |
| 3074F |
|
54 |
47 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
124 |
110 |
$0.00 |
| D1353 |
|
71 |
16 |
$0.00 |
| 3075F |
|
46 |
43 |
$0.00 |
| 90651 |
|
28 |
28 |
$0.00 |
| 90723 |
|
13 |
13 |
$0.00 |
| 3078F |
|
204 |
180 |
$0.00 |
| D0191 |
|
684 |
669 |
$0.00 |
| 99177 |
|
55 |
55 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 90715 |
|
14 |
13 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 90633 |
|
14 |
12 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |