| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
8,023 |
7,798 |
$47K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,019 |
795 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
253 |
231 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
363 |
313 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
158 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
183 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
784 |
691 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
96 |
$16K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,478 |
1,215 |
$15K |
| D1110 |
Prophylaxis - adult |
423 |
384 |
$14K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
596 |
537 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
172 |
144 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
316 |
294 |
$11K |
| D1120 |
Prophylaxis - child |
416 |
358 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
662 |
579 |
$9K |
| D0330 |
Panoramic radiographic image |
113 |
111 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
52 |
42 |
$6K |
| D0272 |
Bitewings - two radiographic images |
303 |
271 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
90 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
262 |
237 |
$4K |
| D0274 |
Bitewings - four radiographic images |
104 |
91 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
262 |
233 |
$2K |
| 90734 |
|
84 |
68 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
260 |
232 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
213 |
190 |
$1K |
| 90651 |
|
49 |
42 |
$1K |
| 90686 |
|
481 |
393 |
$960.82 |
| 90715 |
|
60 |
55 |
$590.36 |
| 81025 |
|
66 |
52 |
$459.84 |
| 96127 |
|
35 |
31 |
$146.22 |
| 87807 |
|
17 |
13 |
$116.12 |
| 90633 |
|
14 |
13 |
$0.00 |
| 90707 |
|
28 |
25 |
$0.00 |
| 90670 |
|
30 |
30 |
$0.00 |
| 99173 |
|
16 |
14 |
$0.00 |
| 2000F |
|
1,386 |
1,140 |
$0.00 |
| 90619 |
|
86 |
60 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |