| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,046 |
15,326 |
$678K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,857 |
6,294 |
$406K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,666 |
2,057 |
$135K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,044 |
5,837 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,660 |
1,483 |
$39K |
| 90686 |
|
3,718 |
3,536 |
$33K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,054 |
1,994 |
$27K |
| 99215 |
Prolong outpt/office vis |
290 |
273 |
$26K |
| D1110 |
Prophylaxis - adult |
774 |
710 |
$24K |
| D1120 |
Prophylaxis - child |
1,134 |
1,021 |
$21K |
| 90791 |
Psychiatric diagnostic evaluation |
218 |
197 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,315 |
1,190 |
$19K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
706 |
666 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
133 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
938 |
704 |
$12K |
| D0274 |
Bitewings - four radiographic images |
684 |
611 |
$11K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
231 |
201 |
$11K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,125 |
1,095 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
569 |
533 |
$8K |
| 90651 |
|
155 |
148 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
142 |
126 |
$7K |
| 90837 |
Psychotherapy, 53 minutes with patient |
88 |
70 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
403 |
364 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
134 |
116 |
$5K |
| 82962 |
|
2,310 |
2,093 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
68 |
$5K |
| T2003 |
Non-emergency transportation; encounter/trip |
444 |
290 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,136 |
1,017 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
83 |
81 |
$5K |
| D0272 |
Bitewings - two radiographic images |
491 |
441 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
79 |
76 |
$4K |
| 99442 |
|
243 |
204 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,045 |
662 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
94 |
92 |
$4K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
39 |
38 |
$3K |
| 99443 |
|
117 |
101 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
239 |
231 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
42 |
42 |
$3K |
| 90715 |
|
115 |
110 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
26 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
40 |
$2K |
| D1351 |
Sealant - per tooth |
100 |
18 |
$1K |
| 90633 |
|
100 |
97 |
$1K |
| 81003 |
|
513 |
478 |
$891.70 |
| 90707 |
|
30 |
28 |
$876.13 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$736.86 |
| 81025 |
|
101 |
99 |
$651.28 |
| 0011A |
|
49 |
49 |
$592.90 |
| 90670 |
|
150 |
146 |
$519.25 |
| 85018 |
|
206 |
197 |
$443.50 |
| 0012A |
|
13 |
13 |
$369.07 |
| 90716 |
|
13 |
13 |
$330.30 |
| G0008 |
Administration of influenza virus vaccine |
15 |
15 |
$281.40 |
| 90714 |
|
15 |
15 |
$272.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$248.38 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$212.74 |
| 90461 |
|
305 |
142 |
$115.00 |
| 90647 |
|
54 |
53 |
$113.00 |
| 90723 |
|
78 |
74 |
$107.25 |
| 90713 |
|
47 |
44 |
$63.00 |
| 96160 |
|
13 |
13 |
$20.75 |
| 91301 |
|
87 |
87 |
$0.55 |
| 3008F |
|
159 |
156 |
$0.00 |
| 3074F |
|
411 |
398 |
$0.00 |
| 3044F |
|
110 |
108 |
$0.00 |
| 3079F |
|
28 |
27 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| 3078F |
|
477 |
464 |
$0.00 |
| 90734 |
|
33 |
28 |
$0.00 |