| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,733 |
9,177 |
$280K |
| H1000 |
Prenatal care, at-risk assessment |
6,702 |
4,153 |
$260K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,587 |
1,257 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,564 |
1,114 |
$64K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,134 |
909 |
$55K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,321 |
1,101 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,577 |
1,555 |
$48K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
702 |
559 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,306 |
926 |
$35K |
| D0330 |
Panoramic radiographic image |
1,793 |
1,729 |
$34K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
483 |
449 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,487 |
2,310 |
$28K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,770 |
2,079 |
$26K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,439 |
952 |
$21K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
297 |
253 |
$19K |
| D1110 |
Prophylaxis - adult |
799 |
792 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,155 |
959 |
$13K |
| 90670 |
|
661 |
496 |
$11K |
| D0274 |
Bitewings - four radiographic images |
814 |
800 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
1,047 |
1,012 |
$9K |
| D1330 |
|
2,054 |
1,988 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,891 |
1,326 |
$7K |
| 99385 |
|
93 |
75 |
$6K |
| D1206 |
Topical application of fluoride varnish |
783 |
747 |
$4K |
| 90461 |
|
1,319 |
636 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
61 |
54 |
$4K |
| 99401 |
|
388 |
349 |
$4K |
| 99381 |
|
86 |
68 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,789 |
1,425 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,047 |
801 |
$2K |
| 59430 |
|
67 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,262 |
2,102 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
2,428 |
2,054 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| 99383 |
|
32 |
25 |
$1K |
| 99386 |
|
13 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
151 |
27 |
$1K |
| 81025 |
|
738 |
533 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
28 |
$1K |
| 92558 |
|
186 |
182 |
$915.89 |
| D1120 |
Prophylaxis - child |
115 |
112 |
$765.18 |
| 91301 |
|
74 |
46 |
$747.05 |
| 3074F |
|
10,939 |
8,669 |
$671.25 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
13 |
$658.53 |
| 81002 |
|
849 |
574 |
$623.52 |
| 90651 |
|
180 |
144 |
$602.86 |
| 90686 |
|
722 |
550 |
$561.69 |
| 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 |
513 |
387 |
$351.55 |
| 90697 |
|
311 |
278 |
$289.64 |
| 0011A |
|
47 |
31 |
$245.63 |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$225.90 |
| 3078F |
|
9,033 |
6,972 |
$208.20 |
| 0012A |
|
43 |
24 |
$200.00 |
| D0191 |
|
135 |
126 |
$182.20 |
| 83655 |
|
80 |
72 |
$180.91 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
148 |
126 |
$179.13 |
| 82962 |
|
491 |
379 |
$175.44 |
| D0603 |
|
1,537 |
1,459 |
$156.00 |
| D0601 |
|
352 |
329 |
$108.29 |
| 90633 |
|
398 |
335 |
$85.85 |
| 90647 |
|
74 |
64 |
$83.60 |
| 85018 |
|
485 |
353 |
$77.37 |
| 90674 |
|
50 |
44 |
$68.34 |
| 90710 |
|
12 |
12 |
$64.00 |
| 3075F |
|
457 |
420 |
$50.00 |
| D0190 |
|
20 |
18 |
$43.52 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$41.73 |
| D9995 |
|
14 |
13 |
$39.00 |
| 99188 |
|
70 |
56 |
$28.20 |
| 2010F |
|
7,431 |
6,172 |
$25.40 |
| 90723 |
|
57 |
52 |
$20.00 |
| 90656 |
|
64 |
64 |
$14.50 |
| 1159F |
|
14,226 |
11,769 |
$11.86 |
| 81003 |
|
1,524 |
1,008 |
$11.32 |
| 90716 |
|
191 |
141 |
$10.00 |
| 2001F |
|
20,113 |
15,534 |
$9.92 |
| 1000F |
|
10,842 |
8,556 |
$1.94 |
| 92551 |
|
1,037 |
734 |
$0.00 |
| 2000F |
|
15,353 |
11,833 |
$0.00 |
| 1126F |
|
5,464 |
4,652 |
$0.00 |
| 1220F |
|
4,260 |
3,837 |
$0.00 |
| 4000F |
|
4,121 |
3,527 |
$0.00 |
| 3008F |
|
12,729 |
10,299 |
$0.00 |
| 3044F |
|
1,603 |
1,333 |
$0.00 |
| 1036F |
|
1,297 |
1,105 |
$0.00 |
| 36416 |
|
118 |
102 |
$0.00 |
| D4999 |
|
613 |
604 |
$0.00 |
| 3079F |
|
2,627 |
2,100 |
$0.00 |
| 90474 |
|
13 |
13 |
$0.00 |
| 1055F |
|
679 |
583 |
$0.00 |
| 4010F |
|
75 |
54 |
$0.00 |
| 99000 |
|
110 |
57 |
$0.00 |
| 4037F |
|
67 |
66 |
$0.00 |
| D1310 |
|
73 |
73 |
$0.00 |
| 3353F |
|
16 |
13 |
$0.00 |
| 96127 |
|
41 |
39 |
$0.00 |
| 3351F |
|
29 |
29 |
$0.00 |
| 90619 |
|
28 |
26 |
$0.00 |
| 3048F |
|
12 |
12 |
$0.00 |
| 0501F |
|
12 |
12 |
$0.00 |
| 1157F |
|
342 |
143 |
$0.00 |
| D0602 |
|
18 |
18 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
19 |
12 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
63 |
13 |
$0.00 |
| 1160F |
|
14,370 |
11,833 |
$0.00 |
| 99173 |
|
1,098 |
769 |
$0.00 |
| 0502F |
|
352 |
225 |
$0.00 |
| 90681 |
|
103 |
94 |
$0.00 |
| 3210F |
|
47 |
39 |
$0.00 |
| 4035F |
|
15 |
15 |
$0.00 |
| 90707 |
|
23 |
14 |
$0.00 |
| 99177 |
|
183 |
177 |
$0.00 |
| 2028F |
|
93 |
80 |
$0.00 |
| 3077F |
|
81 |
62 |
$0.00 |
| 90756 |
|
19 |
12 |
$0.00 |
| 90671 |
|
14 |
14 |
$0.00 |
| 90713 |
|
37 |
30 |
$0.00 |
| 90734 |
|
15 |
15 |
$0.00 |