| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
134,113 |
112,835 |
$684K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,613 |
2,248 |
$419K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,104 |
1,299 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
5,758 |
5,225 |
$150K |
| D1120 |
Prophylaxis - child |
4,449 |
4,002 |
$123K |
| D1206 |
Topical application of fluoride varnish |
6,764 |
6,121 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,529 |
2,545 |
$68K |
| D1351 |
Sealant - per tooth |
1,894 |
407 |
$55K |
| D1110 |
Prophylaxis - adult |
1,474 |
1,323 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,206 |
2,854 |
$49K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
709 |
509 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,025 |
958 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,675 |
1,535 |
$32K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,201 |
996 |
$23K |
| D0274 |
Bitewings - four radiographic images |
680 |
639 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,567 |
1,294 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
386 |
333 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
52 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
244 |
202 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
867 |
730 |
$2K |
| 81002 |
|
552 |
364 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
27 |
$2K |
| 90686 |
|
814 |
752 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
12 |
$1K |
| 90688 |
|
144 |
89 |
$728.71 |
| 81025 |
|
96 |
88 |
$691.44 |
| 90734 |
|
32 |
27 |
$375.00 |
| 0064A |
|
13 |
12 |
$257.00 |
| 90715 |
|
22 |
15 |
$160.44 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
12 |
$135.74 |
| 86592 |
|
89 |
84 |
$13.39 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
58 |
55 |
$9.88 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
70 |
65 |
$0.00 |
| 90685 |
|
30 |
26 |
$0.00 |
| 90649 |
|
15 |
13 |
$0.00 |
| 91300 |
|
25 |
20 |
$0.00 |
| 87390 |
|
101 |
96 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
977 |
825 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
70 |
65 |
$0.00 |
| 91306 |
|
13 |
12 |
$0.00 |