| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,539 |
1,354 |
$44K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
428 |
386 |
$24K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
343 |
319 |
$23K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
589 |
497 |
$19K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
238 |
232 |
$16K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
965 |
908 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
534 |
$13K |
| D1206 |
Topical application of fluoride varnish |
852 |
830 |
$13K |
| D0330 |
Panoramic radiographic image |
255 |
253 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
124 |
$11K |
| D1120 |
Prophylaxis - child |
575 |
567 |
$10K |
| D1351 |
Sealant - per tooth |
423 |
143 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
140 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
89 |
87 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
234 |
233 |
$5K |
| 90461 |
|
593 |
497 |
$3K |
| 99383 |
|
65 |
63 |
$3K |
| D1330 |
|
902 |
877 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
767 |
425 |
$3K |
| 92558 |
|
390 |
386 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
212 |
203 |
$3K |
| 90671 |
|
154 |
139 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
86 |
$2K |
| D0274 |
Bitewings - four radiographic images |
292 |
292 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
159 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
300 |
269 |
$2K |
| D0272 |
Bitewings - two radiographic images |
189 |
189 |
$2K |
| 90661 |
|
104 |
102 |
$1K |
| 83655 |
|
218 |
203 |
$1K |
| D1110 |
Prophylaxis - adult |
37 |
36 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
75 |
68 |
$870.00 |
| 99384 |
|
17 |
15 |
$823.11 |
| D0220 |
Intraoral - periapical first radiographic image |
589 |
465 |
$784.78 |
| D0191 |
|
126 |
125 |
$731.80 |
| D9999 |
Unspecified adjunctive procedure, by report |
26 |
26 |
$650.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
104 |
79 |
$494.44 |
| D0603 |
|
621 |
612 |
$490.00 |
| 85018 |
|
341 |
311 |
$350.94 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
14 |
14 |
$307.98 |
| D0601 |
|
171 |
168 |
$258.00 |
| 92587 |
|
25 |
25 |
$151.07 |
| 36415 |
Collection of venous blood by venipuncture |
290 |
279 |
$122.00 |
| D0602 |
|
65 |
65 |
$116.00 |
| 3074F |
|
2,289 |
2,050 |
$25.00 |
| 90697 |
|
78 |
69 |
$22.00 |
| 99173 |
|
167 |
152 |
$3.05 |
| 3078F |
|
2,233 |
1,989 |
$0.00 |
| 1160F |
|
2,643 |
2,285 |
$0.00 |
| 1159F |
|
2,633 |
2,275 |
$0.00 |
| 99177 |
|
325 |
318 |
$0.00 |
| 3210F |
|
47 |
40 |
$0.00 |
| 90633 |
|
124 |
110 |
$0.00 |
| 90734 |
|
21 |
17 |
$0.00 |
| 90710 |
|
13 |
13 |
$0.00 |
| 90715 |
|
23 |
23 |
$0.00 |
| 1126F |
|
2,203 |
1,977 |
$0.00 |
| 3008F |
|
2,658 |
2,344 |
$0.00 |
| 2000F |
|
2,388 |
2,123 |
$0.00 |
| 90619 |
|
47 |
46 |
$0.00 |
| 2001F |
|
4,053 |
3,477 |
$0.00 |
| 90677 |
|
30 |
29 |
$0.00 |
| 4000F |
|
745 |
699 |
$0.00 |
| 36416 |
|
49 |
45 |
$0.00 |
| 90651 |
|
72 |
69 |
$0.00 |
| 1220F |
|
411 |
377 |
$0.00 |
| 1000F |
|
801 |
718 |
$0.00 |
| 1125F |
|
15 |
15 |
$0.00 |
| 90686 |
|
92 |
79 |
$0.00 |
| D1310 |
|
123 |
121 |
$0.00 |
| 96127 |
|
78 |
74 |
$0.00 |
| 92551 |
|
22 |
21 |
$0.00 |