| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99403 |
|
208,583 |
16,404 |
$2.66M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
25,680 |
6,091 |
$1.02M |
| H1000 |
Prenatal care, at-risk assessment |
56,481 |
3,289 |
$699K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
26,648 |
2,480 |
$380K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
16,282 |
862 |
$128K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12,448 |
10,434 |
$98K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18,634 |
15,325 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,181 |
1,172 |
$61K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,453 |
1,238 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
755 |
745 |
$38K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
32 |
26 |
$28K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
180 |
166 |
$26K |
| T1002 |
Rn services, up to 15 minutes |
6,930 |
6,413 |
$25K |
| D1110 |
Prophylaxis - adult |
661 |
650 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
191 |
$17K |
| D1120 |
Prophylaxis - child |
1,456 |
1,433 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
155 |
$8K |
| 99401 |
|
7,507 |
79 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
64 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,715 |
1,690 |
$6K |
| 99385 |
|
25 |
25 |
$4K |
| 90686 |
|
4,053 |
2,923 |
$4K |
| 90715 |
|
1,382 |
1,287 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
476 |
474 |
$3K |
| 90633 |
|
4,876 |
3,680 |
$3K |
| 99402 |
|
30 |
16 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$2K |
| J0561 |
Injection, penicillin g benzathine, 100,000 units |
349 |
231 |
$2K |
| D1330 |
|
2,402 |
2,364 |
$2K |
| 90651 |
|
3,309 |
3,106 |
$2K |
| 90698 |
|
146 |
138 |
$1K |
| 90734 |
|
775 |
677 |
$984.50 |
| 90670 |
|
611 |
557 |
$803.00 |
| 90700 |
|
249 |
242 |
$671.00 |
| 90710 |
|
918 |
856 |
$539.00 |
| D0140 |
Limited oral evaluation - problem focused |
20 |
20 |
$498.19 |
| 99457 |
|
20 |
19 |
$496.03 |
| 90744 |
|
1,312 |
1,239 |
$396.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
15 |
15 |
$300.00 |
| 90713 |
|
1,590 |
1,515 |
$253.00 |
| 90620 |
|
762 |
687 |
$242.00 |
| 99441 |
|
26 |
24 |
$196.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
336 |
315 |
$186.07 |
| D0274 |
Bitewings - four radiographic images |
62 |
62 |
$159.86 |
| 90480 |
|
44 |
41 |
$143.00 |
| D0190 |
|
262 |
247 |
$130.20 |
| 90716 |
|
2,226 |
1,870 |
$126.50 |
| D9920 |
|
12 |
12 |
$101.66 |
| 90656 |
|
362 |
362 |
$75.00 |
| 90696 |
|
98 |
97 |
$71.50 |
| D9986 |
|
449 |
440 |
$0.00 |
| 90714 |
|
338 |
327 |
$0.00 |
| 90707 |
|
448 |
428 |
$0.00 |
| 90671 |
|
252 |
204 |
$0.00 |
| 90623 |
|
12 |
12 |
$0.00 |
| 90619 |
|
796 |
777 |
$0.00 |
| 91319 |
|
12 |
12 |
$0.00 |
| 90674 |
|
57 |
50 |
$0.00 |