| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,447 |
4,977 |
$88K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
856 |
824 |
$71K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
855 |
811 |
$62K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
371 |
368 |
$36K |
| H1000 |
Prenatal care, at-risk assessment |
1,068 |
689 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
396 |
393 |
$19K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
231 |
222 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
666 |
601 |
$8K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
343 |
106 |
$5K |
| D1110 |
Prophylaxis - adult |
322 |
319 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
397 |
381 |
$4K |
| D1206 |
Topical application of fluoride varnish |
539 |
536 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
235 |
141 |
$3K |
| D1120 |
Prophylaxis - child |
374 |
373 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
178 |
172 |
$2K |
| T1015 |
Clinic visit/encounter, all-inclusive |
125 |
58 |
$2K |
| 97802 |
|
64 |
54 |
$2K |
| 99383 |
|
13 |
13 |
$2K |
| D1330 |
|
951 |
909 |
$2K |
| 3008F |
|
4,771 |
4,200 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,495 |
2,343 |
$2K |
| 80053 |
Comprehensive metabolic panel |
522 |
413 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
336 |
321 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,195 |
1,093 |
$1K |
| 90686 |
|
407 |
401 |
$1K |
| 2001F |
|
3,036 |
1,714 |
$858.88 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$680.73 |
| D0240 |
|
114 |
104 |
$590.21 |
| D0140 |
Limited oral evaluation - problem focused |
55 |
51 |
$451.27 |
| D0274 |
Bitewings - four radiographic images |
148 |
144 |
$429.54 |
| D0220 |
Intraoral - periapical first radiographic image |
641 |
622 |
$353.14 |
| D0272 |
Bitewings - two radiographic images |
171 |
171 |
$299.62 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$227.33 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$223.52 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$220.33 |
| 99188 |
|
114 |
113 |
$217.31 |
| 90734 |
|
57 |
57 |
$118.76 |
| 81025 |
|
100 |
98 |
$111.15 |
| 90670 |
|
187 |
181 |
$87.83 |
| 90633 |
|
128 |
127 |
$70.44 |
| 1000F |
|
1,539 |
1,315 |
$51.04 |
| 3351F |
|
1,562 |
1,343 |
$50.44 |
| 90657 |
|
70 |
65 |
$50.44 |
| 90651 |
|
103 |
103 |
$47.83 |
| V2020 |
Frames, purchases |
18 |
13 |
$44.00 |
| 90658 |
|
137 |
134 |
$40.30 |
| 3725F |
|
559 |
532 |
$25.22 |
| 99177 |
|
180 |
179 |
$25.22 |
| 93000 |
|
64 |
62 |
$24.04 |
| 92551 |
|
385 |
287 |
$12.61 |
| 90474 |
|
26 |
24 |
$10.00 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
308 |
265 |
$0.10 |
| 36415 |
Collection of venous blood by venipuncture |
262 |
104 |
$0.00 |
| 3292F |
|
232 |
132 |
$0.00 |
| 1036F |
|
1,260 |
1,129 |
$0.00 |
| 1126F |
|
130 |
113 |
$0.00 |
| 1157F |
|
224 |
83 |
$0.00 |
| 90647 |
|
25 |
25 |
$0.00 |
| 3074F |
|
108 |
91 |
$0.00 |
| 2000F |
|
33 |
17 |
$0.00 |
| 0513F |
|
62 |
60 |
$0.00 |
| D1310 |
|
12 |
12 |
$0.00 |
| 90698 |
|
16 |
16 |
$0.00 |
| 1220F |
|
26 |
22 |
$0.00 |
| 3293F |
|
231 |
131 |
$0.00 |
| 0502F |
|
241 |
148 |
$0.00 |
| 1160F |
|
58 |
34 |
$0.00 |
| 4004F |
|
144 |
102 |
$0.00 |
| 3078F |
|
113 |
95 |
$0.00 |
| 99173 |
|
256 |
189 |
$0.00 |
| 3015F |
|
83 |
74 |
$0.00 |
| 99201 |
|
14 |
14 |
$0.00 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
37 |
35 |
$0.00 |
| 1159F |
|
57 |
34 |
$0.00 |
| 90710 |
|
13 |
13 |
$0.00 |