| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
311,620 |
251,310 |
$1.38M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,303 |
3,563 |
$902K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,727 |
2,031 |
$472K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,645 |
2,192 |
$378K |
| D0120 |
Periodic oral evaluation - established patient |
11,033 |
10,682 |
$303K |
| D1120 |
Prophylaxis - child |
9,629 |
9,311 |
$285K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,229 |
12,791 |
$223K |
| D1110 |
Prophylaxis - adult |
3,629 |
3,513 |
$151K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,204 |
1,474 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
2,740 |
2,571 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,267 |
2,188 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
5,884 |
5,651 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,490 |
5,263 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,424 |
3,300 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,813 |
1,740 |
$57K |
| D1351 |
Sealant - per tooth |
1,663 |
615 |
$47K |
| D0330 |
Panoramic radiographic image |
724 |
701 |
$41K |
| D2330 |
|
365 |
263 |
$27K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,122 |
1,722 |
$25K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
705 |
637 |
$21K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,043 |
940 |
$19K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
961 |
813 |
$17K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
128 |
104 |
$13K |
| 0012A |
|
263 |
250 |
$11K |
| 0011A |
|
381 |
340 |
$10K |
| 0001A |
|
169 |
79 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
1,929 |
1,437 |
$4K |
| T1002 |
Rn services, up to 15 minutes |
117 |
94 |
$3K |
| D2332 |
|
47 |
24 |
$3K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
181 |
162 |
$3K |
| 87210 |
|
911 |
685 |
$3K |
| 81025 |
|
408 |
315 |
$3K |
| 0064A |
|
74 |
65 |
$2K |
| 82120 |
|
913 |
687 |
$2K |
| D1354 |
|
426 |
84 |
$2K |
| 90734 |
|
780 |
657 |
$2K |
| 0002A |
|
71 |
30 |
$2K |
| 90715 |
|
526 |
437 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27 |
15 |
$926.52 |
| 0071A |
|
35 |
14 |
$845.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
81 |
72 |
$741.96 |
| D9110 |
|
16 |
15 |
$739.28 |
| 96127 |
|
210 |
142 |
$678.92 |
| 0072A |
|
32 |
12 |
$650.00 |
| 90688 |
|
66 |
61 |
$558.78 |
| 81003 |
|
220 |
107 |
$202.43 |
| 87081 |
|
18 |
14 |
$102.62 |
| 85018 |
|
45 |
39 |
$36.12 |
| 90633 |
|
35 |
33 |
$35.80 |
| G0008 |
Administration of influenza virus vaccine |
21 |
21 |
$34.80 |
| 99173 |
|
85 |
77 |
$8.27 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,001 |
798 |
$0.00 |
| 91300 |
|
263 |
111 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,091 |
882 |
$0.00 |
| 86592 |
|
1,116 |
885 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,002 |
799 |
$0.00 |
| 90686 |
|
82 |
68 |
$0.00 |
| 92551 |
|
68 |
63 |
$0.00 |
| 91301 |
|
618 |
545 |
$0.00 |
| 36416 |
|
27 |
26 |
$0.00 |
| 90619 |
|
22 |
18 |
$0.00 |
| 91307 |
|
68 |
20 |
$0.00 |
| 91306 |
|
65 |
56 |
$0.00 |
| 92587 |
|
16 |
13 |
$0.00 |