| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
9,189 |
6,561 |
$970K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16,450 |
14,851 |
$548K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,492 |
3,280 |
$222K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,992 |
5,050 |
$175K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,586 |
2,510 |
$154K |
| D1120 |
Prophylaxis - child |
2,300 |
2,290 |
$64K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
842 |
813 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,840 |
1,834 |
$34K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
436 |
426 |
$29K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,933 |
4,474 |
$28K |
| 99381 |
|
308 |
250 |
$28K |
| 59410 |
|
37 |
37 |
$26K |
| D1206 |
Topical application of fluoride varnish |
3,522 |
3,498 |
$22K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
444 |
403 |
$21K |
| 59430 |
|
433 |
371 |
$21K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
4,298 |
1,907 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,732 |
5,585 |
$18K |
| 92587 |
|
1,910 |
1,809 |
$16K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
563 |
529 |
$16K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,730 |
2,575 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
234 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
381 |
380 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
95 |
48 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,776 |
2,362 |
$10K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
1,665 |
1,618 |
$7K |
| 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 |
1,800 |
1,531 |
$7K |
| D0272 |
Bitewings - two radiographic images |
1,426 |
1,422 |
$7K |
| D1354 |
|
740 |
216 |
$6K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
98 |
64 |
$6K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
311 |
298 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
256 |
240 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,751 |
2,695 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
73 |
73 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
54 |
$4K |
| D1330 |
|
2,634 |
2,621 |
$4K |
| H2010 |
Comprehensive medication services, per 15 minutes |
168 |
117 |
$4K |
| D0603 |
|
2,726 |
2,719 |
$3K |
| 90473 |
|
758 |
745 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
2,495 |
2,221 |
$2K |
| 81025 |
|
983 |
883 |
$2K |
| 99385 |
|
29 |
27 |
$2K |
| 85018 |
|
2,163 |
2,097 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
211 |
$2K |
| 59025 |
Fetal non-stress test |
44 |
25 |
$1K |
| 87807 |
|
275 |
247 |
$995.83 |
| 90670 |
|
760 |
741 |
$964.83 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
12 |
$641.16 |
| 81003 |
|
967 |
693 |
$579.19 |
| 92015 |
Determination of refractive state |
61 |
50 |
$445.29 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
108 |
108 |
$405.79 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$360.00 |
| 0011A |
|
20 |
13 |
$352.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
121 |
112 |
$337.76 |
| 1036F |
|
11,789 |
9,021 |
$334.67 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$300.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
18 |
17 |
$235.00 |
| 1160F |
|
13,557 |
11,763 |
$196.49 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$107.33 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$98.50 |
| 90656 |
|
375 |
370 |
$44.77 |
| 90686 |
|
1,493 |
1,475 |
$30.57 |
| 3074F |
|
14,130 |
12,519 |
$25.00 |
| 99000 |
|
4,889 |
4,188 |
$15.00 |
| 90671 |
|
862 |
853 |
$0.16 |
| 90648 |
|
2,409 |
2,364 |
$0.04 |
| 90633 |
|
851 |
842 |
$0.03 |
| 90677 |
|
740 |
723 |
$0.03 |
| 90674 |
|
94 |
90 |
$0.02 |
| 90723 |
|
1,769 |
1,736 |
$0.01 |
| 90681 |
|
817 |
799 |
$0.00 |
| 3078F |
|
14,278 |
11,255 |
$0.00 |
| 3725F |
|
3,034 |
2,550 |
$0.00 |
| D9986 |
|
272 |
269 |
$0.00 |
| 3077F |
|
108 |
81 |
$0.00 |
| 90672 |
|
18 |
18 |
$0.00 |
| 99173 |
|
97 |
83 |
$0.00 |
| 90715 |
|
28 |
26 |
$0.00 |
| 90707 |
|
34 |
34 |
$0.00 |
| 90734 |
|
50 |
50 |
$0.00 |
| 90700 |
|
25 |
25 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
37 |
34 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
14 |
12 |
$0.00 |
| 3079F |
|
1,656 |
1,305 |
$0.00 |
| 88720 |
|
476 |
314 |
$0.00 |
| 3008F |
|
16,670 |
13,499 |
$0.00 |
| 1126F |
|
3,196 |
2,854 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
807 |
768 |
$0.00 |
| 99174 |
|
489 |
392 |
$0.00 |
| 91301 |
|
23 |
16 |
$0.00 |
| 90651 |
|
98 |
96 |
$0.00 |
| 1125F |
|
108 |
100 |
$0.00 |
| 3075F |
|
177 |
167 |
$0.00 |
| 90716 |
|
34 |
34 |
$0.00 |
| 36416 |
|
85 |
80 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
38 |
35 |
$0.00 |
| 3080F |
|
27 |
17 |
$0.00 |
| 90620 |
|
13 |
13 |
$0.00 |
| D8999 |
|
26 |
13 |
$0.00 |
| 3044F |
|
14 |
13 |
$0.00 |