| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
242,784 |
239,190 |
$1.26M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,116 |
1,286 |
$66K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,662 |
3,980 |
$64K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,219 |
1,689 |
$50K |
| D1120 |
Prophylaxis - child |
543 |
501 |
$13K |
| 90651 |
|
568 |
453 |
$12K |
| 59426 |
|
23 |
13 |
$12K |
| D1206 |
Topical application of fluoride varnish |
630 |
584 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
208 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
368 |
336 |
$8K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
541 |
355 |
$8K |
| 90715 |
|
972 |
727 |
$7K |
| 81025 |
|
1,072 |
644 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
581 |
374 |
$6K |
| 90734 |
|
487 |
429 |
$5K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
80 |
38 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
552 |
345 |
$4K |
| 90620 |
|
365 |
237 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
2,464 |
1,644 |
$4K |
| 90686 |
|
931 |
719 |
$4K |
| D0272 |
Bitewings - two radiographic images |
238 |
217 |
$4K |
| 90619 |
|
1,033 |
677 |
$3K |
| 81003 |
|
2,069 |
1,351 |
$3K |
| T1002 |
Rn services, up to 15 minutes |
59 |
38 |
$3K |
| D0330 |
Panoramic radiographic image |
19 |
18 |
$888.75 |
| 90688 |
|
85 |
66 |
$846.20 |
| 90480 |
|
23 |
13 |
$715.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
85 |
66 |
$678.86 |
| 85018 |
|
310 |
278 |
$660.39 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,092 |
877 |
$502.50 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,010 |
822 |
$496.50 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,080 |
866 |
$342.24 |
| 87210 |
|
82 |
56 |
$289.64 |
| 90633 |
|
188 |
153 |
$270.00 |
| 82120 |
|
82 |
56 |
$261.81 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$208.74 |
| 90656 |
|
40 |
36 |
$194.94 |
| 86580 |
|
39 |
26 |
$167.70 |
| 94760 |
|
267 |
124 |
$120.51 |
| 86592 |
|
1,056 |
858 |
$112.52 |
| 96127 |
|
13 |
13 |
$62.52 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
80 |
77 |
$12.48 |
| 99173 |
|
90 |
71 |
$12.27 |
| 92551 |
|
90 |
71 |
$8.42 |
| LU232 |
|
518 |
455 |
$0.00 |
| 99000 |
|
1,699 |
1,328 |
$0.00 |
| LU014 |
|
291 |
222 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
50 |
49 |
$0.00 |
| LU233 |
|
178 |
122 |
$0.00 |
| 90710 |
|
128 |
97 |
$0.00 |
| LU238 |
|
2,034 |
1,591 |
$0.00 |
| 90700 |
|
111 |
67 |
$0.00 |
| 90713 |
|
12 |
12 |
$0.00 |