| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
532,082 |
528,570 |
$2.82M |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
456 |
415 |
$65K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,319 |
1,091 |
$36K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,361 |
1,945 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,066 |
988 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,540 |
1,490 |
$29K |
| D1120 |
Prophylaxis - child |
791 |
765 |
$26K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,012 |
1,733 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
107 |
$20K |
| 87210 |
|
3,875 |
1,923 |
$19K |
| D1110 |
Prophylaxis - adult |
412 |
397 |
$18K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,136 |
978 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
240 |
166 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
111 |
90 |
$11K |
| 99385 |
|
58 |
56 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
393 |
381 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
124 |
$8K |
| 81025 |
|
1,021 |
809 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
212 |
208 |
$7K |
| 36415 |
Collection of venous blood by venipuncture |
2,795 |
2,082 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
327 |
240 |
$5K |
| 83986 |
|
1,314 |
972 |
$5K |
| D1351 |
Sealant - per tooth |
186 |
49 |
$4K |
| T1002 |
Rn services, up to 15 minutes |
117 |
110 |
$4K |
| D0330 |
Panoramic radiographic image |
46 |
46 |
$3K |
| D0272 |
Bitewings - two radiographic images |
135 |
127 |
$3K |
| D0274 |
Bitewings - four radiographic images |
43 |
40 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
15 |
$1K |
| 90480 |
|
14 |
12 |
$780.00 |
| 90734 |
|
344 |
260 |
$0.99 |
| 90651 |
|
294 |
240 |
$0.00 |
| 90686 |
|
317 |
273 |
$0.00 |
| 90619 |
|
521 |
394 |
$0.00 |
| 90620 |
|
128 |
85 |
$0.00 |
| 90715 |
|
459 |
358 |
$0.00 |
| 90633 |
|
90 |
82 |
$0.00 |
| 90710 |
|
34 |
25 |
$0.00 |
| 90713 |
|
14 |
14 |
$0.00 |