| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,469 |
7,029 |
$224K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,114 |
2,380 |
$90K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
633 |
584 |
$61K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
2,227 |
1,362 |
$53K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,567 |
1,036 |
$49K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
423 |
388 |
$33K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
449 |
407 |
$31K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,350 |
1,148 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
434 |
425 |
$12K |
| H1000 |
Prenatal care, at-risk assessment |
237 |
173 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,438 |
2,272 |
$9K |
| 36415 |
Collection of venous blood by venipuncture |
2,386 |
2,096 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,239 |
752 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
584 |
$7K |
| D1110 |
Prophylaxis - adult |
395 |
382 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
39 |
37 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
135 |
$5K |
| D0274 |
Bitewings - four radiographic images |
546 |
525 |
$5K |
| D1120 |
Prophylaxis - child |
280 |
277 |
$4K |
| 3074F |
|
6,110 |
4,679 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
555 |
532 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
899 |
823 |
$3K |
| H2000 |
Comprehensive multidisciplinary evaluation |
93 |
66 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
73 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
220 |
210 |
$2K |
| 90619 |
|
85 |
78 |
$2K |
| 90661 |
|
103 |
102 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
184 |
145 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
294 |
$2K |
| D1206 |
Topical application of fluoride varnish |
275 |
271 |
$2K |
| 90670 |
|
15 |
15 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
26 |
$1K |
| D1330 |
|
619 |
601 |
$983.57 |
| D0220 |
Intraoral - periapical first radiographic image |
1,087 |
969 |
$965.41 |
| 90686 |
|
681 |
656 |
$927.91 |
| 92015 |
Determination of refractive state |
188 |
171 |
$883.72 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
39 |
$860.01 |
| 90671 |
|
18 |
18 |
$848.39 |
| 3008F |
|
10,321 |
7,798 |
$764.58 |
| 1000F |
|
7,070 |
5,302 |
$739.72 |
| 81025 |
|
382 |
310 |
$611.54 |
| 90461 |
|
62 |
53 |
$489.01 |
| D4341 |
|
31 |
25 |
$444.36 |
| 2001F |
|
10,967 |
7,905 |
$430.78 |
| 99201 |
|
17 |
17 |
$411.19 |
| 97802 |
|
16 |
12 |
$373.41 |
| 91301 |
|
17 |
16 |
$314.61 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
16 |
$299.94 |
| S9470 |
Nutritional counseling, dietitian visit |
100 |
66 |
$251.30 |
| 91300 |
|
13 |
13 |
$216.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
25 |
$199.39 |
| 90651 |
|
201 |
186 |
$166.61 |
| 3075F |
|
62 |
53 |
$150.00 |
| 90715 |
|
13 |
13 |
$124.17 |
| 3044F |
|
1,098 |
776 |
$57.83 |
| 1159F |
|
6,466 |
4,912 |
$50.44 |
| 3351F |
|
593 |
546 |
$43.13 |
| 82962 |
|
77 |
68 |
$30.74 |
| 81002 |
|
45 |
33 |
$27.26 |
| 4004F |
|
441 |
406 |
$25.23 |
| 3078F |
|
5,427 |
4,057 |
$25.22 |
| 99173 |
|
133 |
131 |
$16.82 |
| 92551 |
|
124 |
123 |
$11.56 |
| D0603 |
|
13 |
13 |
$6.00 |
| 1126F |
|
5,551 |
4,336 |
$0.00 |
| 1220F |
|
4,571 |
3,595 |
$0.00 |
| 3048F |
|
17 |
13 |
$0.00 |
| 3079F |
|
546 |
404 |
$0.00 |
| 2000F |
|
7,733 |
5,517 |
$0.00 |
| 1101F |
|
51 |
45 |
$0.00 |
| 3352F |
|
343 |
316 |
$0.00 |
| 36416 |
|
60 |
51 |
$0.00 |
| 92250 |
|
93 |
74 |
$0.00 |
| 1036F |
|
53 |
53 |
$0.00 |
| 4000F |
|
481 |
341 |
$0.00 |
| 1125F |
|
402 |
337 |
$0.00 |
| 3353F |
|
13 |
13 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
34 |
28 |
$0.00 |
| 1170F |
|
52 |
45 |
$0.00 |
| 92558 |
|
13 |
13 |
$0.00 |
| 1157F |
|
50 |
17 |
$0.00 |
| 3292F |
|
19 |
14 |
$0.00 |
| 1160F |
|
6,470 |
4,909 |
$0.00 |
| 2028F |
|
146 |
123 |
$0.00 |
| 3725F |
|
82 |
82 |
$0.00 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
125 |
117 |
$0.00 |
| 3288F |
|
53 |
45 |
$0.00 |
| 3077F |
|
81 |
66 |
$0.00 |
| 0502F |
|
37 |
26 |
$0.00 |
| 1033F |
|
51 |
50 |
$0.00 |
| 3293F |
|
56 |
41 |
$0.00 |
| 90633 |
|
38 |
37 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 99408 |
|
31 |
30 |
$0.00 |
| 1090F |
|
52 |
45 |
$0.00 |