| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,929 |
11,721 |
$1.02M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,519 |
6,186 |
$752K |
| D1120 |
Prophylaxis - child |
12,419 |
5,832 |
$645K |
| D0120 |
Periodic oral evaluation - established patient |
10,408 |
7,304 |
$576K |
| D1110 |
Prophylaxis - adult |
4,894 |
3,513 |
$295K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,352 |
2,049 |
$227K |
| D0140 |
Limited oral evaluation - problem focused |
3,276 |
1,507 |
$115K |
| 90832 |
Psychotherapy, 30 minutes with patient |
567 |
270 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,824 |
2,711 |
$75K |
| D1351 |
Sealant - per tooth |
2,343 |
520 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,286 |
1,205 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
579 |
318 |
$32K |
| D0603 |
|
1,012 |
838 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
231 |
$27K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
817 |
732 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
248 |
136 |
$13K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
126 |
53 |
$7K |
| 99051 |
|
809 |
783 |
$7K |
| 90686 |
|
469 |
372 |
$6K |
| 96127 |
|
445 |
170 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
65 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
253 |
245 |
$5K |
| 90834 |
Psychotherapy, 45 minutes with patient |
67 |
38 |
$5K |
| 0012A |
|
144 |
144 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
265 |
249 |
$4K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
231 |
84 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
1,779 |
1,617 |
$3K |
| 0011A |
|
157 |
157 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
209 |
207 |
$3K |
| 99406 |
|
183 |
129 |
$3K |
| D0601 |
|
1,013 |
952 |
$2K |
| 92551 |
|
311 |
306 |
$2K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
177 |
135 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
14 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$1K |
| 99173 |
|
242 |
187 |
$1K |
| 0064A |
|
27 |
27 |
$989.58 |
| 0071A |
|
33 |
33 |
$855.00 |
| D1354 |
|
27 |
12 |
$777.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$770.00 |
| 97803 |
|
17 |
16 |
$646.88 |
| 0072A |
|
26 |
26 |
$641.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
13 |
13 |
$285.59 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$149.40 |
| D9995 |
|
742 |
740 |
$83.62 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$45.00 |
| 99177 |
|
12 |
12 |
$3.10 |
| D1310 |
|
207 |
207 |
$0.00 |
| 91301 |
|
166 |
161 |
$0.00 |
| D0602 |
|
114 |
114 |
$0.00 |
| 99000 |
|
122 |
117 |
$0.00 |
| 2000F |
|
31 |
25 |
$0.00 |
| 3008F |
|
29 |
25 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
111 |
111 |
$0.00 |
| D1999 |
|
31 |
29 |
$0.00 |
| 3028F |
|
31 |
25 |
$0.00 |