| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
76,981 |
62,902 |
$3.76M |
| T1015 |
Clinic visit/encounter, all-inclusive |
60,913 |
48,954 |
$776K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,432 |
9,779 |
$622K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12,372 |
10,709 |
$417K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,570 |
2,286 |
$239K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,752 |
2,517 |
$220K |
| D1120 |
Prophylaxis - child |
7,101 |
6,583 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
9,288 |
8,560 |
$189K |
| D1110 |
Prophylaxis - adult |
4,220 |
3,889 |
$188K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,932 |
1,774 |
$158K |
| D9999 |
Unspecified adjunctive procedure, by report |
15,451 |
12,251 |
$152K |
| 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 |
5,747 |
4,268 |
$143K |
| D0330 |
Panoramic radiographic image |
3,300 |
2,950 |
$137K |
| D1206 |
Topical application of fluoride varnish |
6,030 |
5,607 |
$129K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,466 |
1,368 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
3,150 |
2,447 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,004 |
2,691 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
2,639 |
2,213 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,230 |
567 |
$93K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,445 |
4,009 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,731 |
1,146 |
$85K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,156 |
7,316 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
889 |
641 |
$75K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,126 |
976 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,305 |
2,039 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,321 |
3,097 |
$49K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
385 |
350 |
$31K |
| 36415 |
Collection of venous blood by venipuncture |
9,955 |
8,567 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,063 |
1,673 |
$24K |
| D1351 |
Sealant - per tooth |
932 |
250 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,299 |
1,194 |
$23K |
| 87430 |
|
2,259 |
2,032 |
$20K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,898 |
2,680 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
241 |
220 |
$16K |
| 97803 |
|
7,367 |
6,256 |
$13K |
| 81025 |
|
1,776 |
1,543 |
$11K |
| 90686 |
|
1,526 |
1,376 |
$7K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
922 |
818 |
$7K |
| 81003 |
|
2,789 |
2,378 |
$4K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
56 |
45 |
$4K |
| 80305 |
|
522 |
454 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
437 |
248 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
538 |
465 |
$3K |
| D2335 |
|
18 |
12 |
$2K |
| D4342 |
|
38 |
24 |
$2K |
| D2331 |
|
13 |
12 |
$2K |
| D4341 |
|
27 |
12 |
$2K |
| 36416 |
|
452 |
418 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$994.00 |
| 85018 |
|
436 |
402 |
$858.06 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
15 |
13 |
$754.08 |
| 96127 |
|
165 |
161 |
$480.61 |
| 83655 |
|
27 |
27 |
$318.48 |
| 99173 |
|
187 |
162 |
$245.21 |
| 97802 |
|
27 |
27 |
$19.22 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
15 |
12 |
$1.24 |
| 90734 |
|
127 |
119 |
$0.00 |
| 90670 |
|
106 |
104 |
$0.00 |
| 90710 |
|
84 |
82 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
41 |
38 |
$0.00 |
| 90649 |
|
42 |
29 |
$0.00 |
| 90715 |
|
50 |
41 |
$0.00 |
| 82948 |
|
15 |
13 |
$0.00 |
| G0247 |
Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails |
14 |
13 |
$0.00 |
| 90633 |
|
13 |
13 |
$0.00 |
| 90619 |
|
110 |
80 |
$0.00 |
| S0612 |
Annual gynecological examination, established patient |
26 |
25 |
$0.00 |
| 90688 |
|
66 |
66 |
$0.00 |
| 90656 |
|
87 |
85 |
$0.00 |
| 90677 |
|
100 |
98 |
$0.00 |
| 90651 |
|
292 |
265 |
$0.00 |
| 90698 |
|
58 |
56 |
$0.00 |
| 90647 |
|
12 |
12 |
$0.00 |