| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,537 |
4,591 |
$377K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,711 |
5,889 |
$274K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,114 |
2,785 |
$149K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,027 |
1,954 |
$139K |
| 99381 |
|
1,505 |
1,089 |
$94K |
| D0603 |
|
4,262 |
3,831 |
$71K |
| D1120 |
Prophylaxis - child |
3,571 |
3,418 |
$38K |
| D0330 |
Panoramic radiographic image |
1,095 |
979 |
$36K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,010 |
927 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,383 |
1,278 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
980 |
601 |
$26K |
| D1110 |
Prophylaxis - adult |
811 |
757 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,907 |
5,519 |
$21K |
| D0601 |
|
653 |
624 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
3,238 |
3,082 |
$20K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,647 |
3,318 |
$17K |
| D1206 |
Topical application of fluoride varnish |
4,825 |
4,571 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,042 |
1,817 |
$10K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
108 |
106 |
$10K |
| D1351 |
Sealant - per tooth |
959 |
374 |
$10K |
| D0602 |
|
899 |
853 |
$10K |
| D1330 |
|
7,052 |
6,089 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
1,435 |
1,224 |
$6K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
991 |
905 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
66 |
66 |
$5K |
| 90686 |
|
1,993 |
1,886 |
$4K |
| 90670 |
|
1,357 |
1,196 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
412 |
410 |
$3K |
| 99442 |
|
172 |
165 |
$3K |
| 90698 |
|
589 |
541 |
$3K |
| 99385 |
|
28 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,716 |
1,630 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,797 |
1,645 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
464 |
429 |
$2K |
| 90474 |
|
924 |
860 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
54 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
31 |
$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 |
277 |
217 |
$2K |
| 90681 |
|
993 |
921 |
$1K |
| D1310 |
|
5,778 |
4,923 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
3,803 |
3,351 |
$1K |
| 99441 |
|
123 |
114 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
16 |
$1K |
| 82948 |
|
855 |
751 |
$867.40 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$862.11 |
| D2140 |
|
16 |
14 |
$807.81 |
| D0190 |
|
290 |
284 |
$802.50 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
338 |
310 |
$797.66 |
| 90685 |
|
131 |
121 |
$750.00 |
| 90633 |
|
751 |
708 |
$729.56 |
| 90744 |
|
173 |
140 |
$710.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$565.82 |
| D4341 |
|
115 |
12 |
$424.01 |
| 90723 |
|
49 |
42 |
$270.00 |
| 90648 |
|
154 |
129 |
$190.00 |
| 90716 |
|
104 |
99 |
$60.00 |
| 90480 |
|
21 |
14 |
$45.85 |
| D1354 |
|
46 |
16 |
$45.00 |
| 3044F |
|
99 |
97 |
$40.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
137 |
130 |
$27.06 |
| 90671 |
|
929 |
912 |
$0.00 |
| D9993 |
|
5,079 |
4,806 |
$0.00 |
| 90700 |
|
92 |
92 |
$0.00 |
| 3725F |
|
1,152 |
1,051 |
$0.00 |
| 1160F |
|
544 |
511 |
$0.00 |
| 90707 |
|
73 |
69 |
$0.00 |
| 1159F |
|
570 |
537 |
$0.00 |
| 3078F |
|
479 |
440 |
$0.00 |
| 3008F |
|
1,432 |
1,317 |
$0.00 |
| 90656 |
|
72 |
72 |
$0.00 |
| 3351F |
|
1,116 |
1,020 |
$0.00 |
| 3075F |
|
31 |
31 |
$0.00 |
| 3074F |
|
565 |
533 |
$0.00 |
| 3079F |
|
143 |
135 |
$0.00 |
| 90657 |
|
30 |
30 |
$0.00 |
| 90697 |
|
828 |
776 |
$0.00 |
| 90674 |
|
77 |
76 |
$0.00 |
| 1170F |
|
33 |
27 |
$0.00 |
| 1126F |
|
12 |
12 |
$0.00 |
| 17250 |
|
80 |
39 |
$0.00 |