| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,971 |
6,969 |
$4.07M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,259 |
3,594 |
$1.86M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,852 |
2,480 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
1,229 |
1,144 |
$771K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
268 |
$182K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
254 |
138 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
189 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
482 |
446 |
$89K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
167 |
163 |
$73K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
152 |
107 |
$60K |
| 99442 |
|
101 |
93 |
$54K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
107 |
106 |
$53K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
57 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
91 |
$40K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
74 |
66 |
$24K |
| D1120 |
Prophylaxis - child |
302 |
271 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,111 |
1,033 |
$19K |
| D0274 |
Bitewings - four radiographic images |
415 |
392 |
$15K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
15 |
15 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$8K |
| D1110 |
Prophylaxis - adult |
323 |
301 |
$7K |
| 81003 |
|
110 |
79 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$5K |
| D9211 |
|
14 |
12 |
$3K |
| 99499 |
|
328 |
260 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
28 |
28 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
125 |
117 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65 |
42 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
26 |
24 |
$0.00 |
| 90686 |
|
42 |
39 |
$0.00 |
| D9215 |
|
60 |
51 |
$0.00 |