| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,954 |
16,087 |
$703K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,797 |
2,750 |
$184K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,419 |
2,277 |
$163K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,175 |
2,141 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
6,624 |
5,897 |
$126K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,079 |
1,930 |
$107K |
| D1110 |
Prophylaxis - adult |
2,587 |
2,276 |
$105K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,409 |
1,383 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,545 |
883 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,665 |
980 |
$30K |
| D0240 |
|
832 |
608 |
$20K |
| D1206 |
Topical application of fluoride varnish |
7,159 |
6,405 |
$19K |
| D1351 |
Sealant - per tooth |
1,195 |
467 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
389 |
378 |
$13K |
| D0272 |
Bitewings - two radiographic images |
2,043 |
1,742 |
$10K |
| 99215 |
Prolong outpt/office vis |
141 |
139 |
$10K |
| D1330 |
|
7,314 |
6,550 |
$9K |
| D1120 |
Prophylaxis - child |
2,763 |
2,451 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
531 |
$6K |
| 99381 |
|
88 |
82 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,290 |
4,184 |
$5K |
| 99188 |
|
653 |
649 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,736 |
2,674 |
$4K |
| 90474 |
|
842 |
831 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,900 |
1,603 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
150 |
150 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
173 |
173 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,305 |
1,715 |
$1K |
| 85018 |
|
1,862 |
1,811 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
62 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
65 |
59 |
$633.84 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
17 |
17 |
$588.20 |
| D0220 |
Intraoral - periapical first radiographic image |
2,839 |
2,323 |
$549.25 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
12 |
$301.00 |
| 81002 |
|
352 |
339 |
$272.66 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
44 |
40 |
$128.40 |
| 90461 |
|
29 |
28 |
$100.00 |
| 90686 |
|
1,459 |
1,431 |
$40.94 |
| 90700 |
|
219 |
218 |
$28.02 |
| D0603 |
|
28 |
27 |
$19.00 |
| 90633 |
|
832 |
822 |
$15.00 |
| 90648 |
|
177 |
176 |
$12.45 |
| 90710 |
|
162 |
160 |
$5.00 |
| 97803 |
|
8,369 |
7,934 |
$0.07 |
| 90697 |
|
582 |
575 |
$0.00 |
| 3008F |
|
16,421 |
14,830 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
8,773 |
8,314 |
$0.00 |
| 1036F |
|
3,723 |
3,460 |
$0.00 |
| 1126F |
|
12,035 |
10,971 |
$0.00 |
| 3074F |
|
12,016 |
11,089 |
$0.00 |
| 1220F |
|
42 |
41 |
$0.00 |
| 90651 |
|
638 |
633 |
$0.00 |
| 90680 |
|
761 |
748 |
$0.00 |
| 90698 |
|
493 |
487 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
288 |
254 |
$0.00 |
| 90696 |
|
118 |
116 |
$0.00 |
| 90716 |
|
245 |
244 |
$0.00 |
| 97802 |
|
1,039 |
993 |
$0.00 |
| 90656 |
|
129 |
129 |
$0.00 |
| 90620 |
|
67 |
66 |
$0.00 |
| 2000F |
|
255 |
248 |
$0.00 |
| 90619 |
|
244 |
240 |
$0.00 |
| 1125F |
|
235 |
224 |
$0.00 |
| 2001F |
|
404 |
386 |
$0.00 |
| 90744 |
|
135 |
135 |
$0.00 |
| 4000F |
|
51 |
50 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
14 |
13 |
$0.00 |
| 1000F |
|
20 |
19 |
$0.00 |
| 90681 |
|
103 |
103 |
$0.00 |
| 90670 |
|
1,284 |
1,258 |
$0.00 |
| 1159F |
|
11,236 |
10,057 |
$0.00 |
| 90671 |
|
445 |
442 |
$0.00 |
| 3725F |
|
4,130 |
3,771 |
$0.00 |
| 3078F |
|
11,727 |
10,839 |
$0.00 |
| 1160F |
|
11,245 |
10,069 |
$0.00 |
| 90715 |
|
177 |
175 |
$0.00 |
| 90734 |
|
89 |
89 |
$0.00 |
| 90707 |
|
269 |
268 |
$0.00 |
| D0191 |
|
24 |
23 |
$0.00 |