| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
264,676 |
178,153 |
$1.84M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,886 |
7,759 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
17,990 |
17,620 |
$532K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,676 |
4,667 |
$424K |
| D1206 |
Topical application of fluoride varnish |
20,167 |
19,556 |
$357K |
| D1110 |
Prophylaxis - adult |
7,789 |
7,600 |
$335K |
| D1120 |
Prophylaxis - child |
10,521 |
10,319 |
$333K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,184 |
1,757 |
$257K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,338 |
1,956 |
$216K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,218 |
1,950 |
$199K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,138 |
1,798 |
$156K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
10,412 |
8,710 |
$135K |
| D0330 |
Panoramic radiographic image |
1,983 |
1,924 |
$133K |
| D0274 |
Bitewings - four radiographic images |
3,563 |
3,454 |
$126K |
| D0272 |
Bitewings - two radiographic images |
5,519 |
5,399 |
$118K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,382 |
1,159 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,274 |
1,054 |
$108K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,319 |
3,694 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,853 |
1,739 |
$91K |
| D1351 |
Sealant - per tooth |
2,838 |
737 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,029 |
1,915 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
3,337 |
3,170 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
775 |
536 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
907 |
$50K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
1,490 |
1,314 |
$42K |
| 96127 |
|
5,114 |
4,330 |
$35K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,415 |
2,934 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,237 |
1,023 |
$30K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,848 |
840 |
$20K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,205 |
1,041 |
$18K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
1,834 |
1,253 |
$17K |
| 0002A |
|
521 |
351 |
$17K |
| 0001A |
|
516 |
350 |
$16K |
| 92552 |
|
3,954 |
3,392 |
$13K |
| 0071A |
|
269 |
165 |
$10K |
| 0072A |
|
215 |
139 |
$9K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
70 |
53 |
$8K |
| 90686 |
|
3,794 |
3,232 |
$7K |
| 90651 |
|
288 |
252 |
$6K |
| 96160 |
|
2,929 |
2,517 |
$6K |
| 90734 |
|
1,013 |
779 |
$6K |
| 0004A |
|
136 |
91 |
$5K |
| 96161 |
|
2,248 |
1,962 |
$5K |
| 90834 |
Psychotherapy, 45 minutes with patient |
70 |
50 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
118 |
84 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
273 |
149 |
$3K |
| 90474 |
|
240 |
192 |
$3K |
| D2940 |
|
47 |
33 |
$3K |
| D2140 |
|
37 |
35 |
$3K |
| D1354 |
|
310 |
144 |
$2K |
| 0124A |
|
50 |
29 |
$2K |
| 0012A |
|
42 |
41 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
768 |
666 |
$2K |
| 99173 |
|
5,532 |
4,729 |
$2K |
| 90620 |
|
125 |
95 |
$2K |
| 0064A |
|
41 |
27 |
$2K |
| 90715 |
|
377 |
305 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
15 |
$1K |
| 97803 |
|
46 |
44 |
$1K |
| 90480 |
|
56 |
46 |
$1K |
| 0074A |
|
43 |
17 |
$1K |
| D2331 |
|
13 |
12 |
$973.92 |
| 81025 |
|
115 |
98 |
$747.72 |
| 97802 |
|
12 |
12 |
$686.28 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
12 |
$626.23 |
| 90656 |
|
169 |
138 |
$527.80 |
| 87430 |
|
13 |
13 |
$189.41 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,135 |
985 |
$135.03 |
| 90662 |
|
15 |
14 |
$114.00 |
| 92551 |
|
198 |
192 |
$102.70 |
| 83655 |
|
206 |
153 |
$62.14 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
647 |
552 |
$60.48 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
647 |
552 |
$60.48 |
| 81002 |
|
15 |
12 |
$28.76 |
| 85018 |
|
26 |
13 |
$28.24 |
| 90633 |
|
120 |
98 |
$26.00 |
| 90670 |
|
825 |
703 |
$0.00 |
| 91300 |
|
1,231 |
769 |
$0.00 |
| 80061 |
Lipid panel |
164 |
138 |
$0.00 |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
285 |
275 |
$0.00 |
| 90700 |
|
18 |
15 |
$0.00 |
| 91312 |
|
50 |
29 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
13 |
12 |
$0.00 |
| 90710 |
|
20 |
12 |
$0.00 |
| 90698 |
|
152 |
149 |
$0.00 |
| 36416 |
|
895 |
720 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
196 |
169 |
$0.00 |
| 90723 |
|
338 |
277 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
453 |
425 |
$0.00 |
| 91301 |
|
60 |
58 |
$0.00 |
| 90647 |
|
382 |
313 |
$0.00 |
| 91307 |
|
538 |
293 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
115 |
92 |
$0.00 |
| 91306 |
|
41 |
27 |
$0.00 |
| 90680 |
|
242 |
194 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
24 |
24 |
$0.00 |
| 90677 |
|
85 |
85 |
$0.00 |
| 87081 |
|
13 |
13 |
$0.00 |
| 90744 |
|
15 |
13 |
$0.00 |
| 88142 |
|
12 |
12 |
$0.00 |