| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,824 |
3,087 |
$114K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
23,561 |
21,153 |
$107K |
| D1999 |
|
3,883 |
3,357 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
3,002 |
2,391 |
$44K |
| D0330 |
Panoramic radiographic image |
1,159 |
1,017 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,479 |
2,089 |
$37K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,189 |
4,003 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,718 |
1,362 |
$36K |
| 0004A |
|
820 |
803 |
$31K |
| 0002A |
|
923 |
837 |
$29K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,221 |
2,097 |
$28K |
| 0001A |
|
825 |
779 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,662 |
1,320 |
$24K |
| 99050 |
|
725 |
666 |
$22K |
| 96160 |
|
837 |
818 |
$19K |
| D1120 |
Prophylaxis - child |
870 |
679 |
$17K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,850 |
1,785 |
$11K |
| 0071A |
|
304 |
303 |
$11K |
| 0072A |
|
282 |
279 |
$11K |
| 0012A |
|
307 |
263 |
$10K |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,112 |
2,931 |
$9K |
| 0011A |
|
260 |
253 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102 |
82 |
$5K |
| 0064A |
|
114 |
114 |
$4K |
| 90791 |
Psychiatric diagnostic evaluation |
474 |
466 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
892 |
203 |
$3K |
| 0054A |
|
74 |
55 |
$3K |
| D2140 |
|
66 |
39 |
$3K |
| 97802 |
|
112 |
112 |
$2K |
| 90670 |
|
1,004 |
954 |
$2K |
| 90658 |
|
446 |
435 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
230 |
$1K |
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
480 |
456 |
$1K |
| 90716 |
|
654 |
630 |
$1K |
| D1351 |
Sealant - per tooth |
79 |
12 |
$1K |
| 90707 |
|
648 |
621 |
$970.42 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
90 |
87 |
$900.00 |
| 90633 |
|
387 |
370 |
$869.15 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
50 |
44 |
$845.07 |
| 97803 |
|
39 |
39 |
$832.66 |
| 90649 |
|
221 |
202 |
$804.00 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$788.64 |
| 90474 |
|
97 |
93 |
$760.49 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$745.62 |
| 99442 |
|
512 |
466 |
$736.82 |
| 90648 |
|
324 |
303 |
$649.13 |
| 84443 |
Thyroid stimulating hormone (TSH) |
127 |
115 |
$640.85 |
| 90698 |
|
246 |
234 |
$640.42 |
| 0003A |
|
17 |
17 |
$600.00 |
| 80061 |
Lipid panel |
126 |
115 |
$459.13 |
| 90715 |
|
329 |
312 |
$448.86 |
| 87590 |
|
49 |
43 |
$426.84 |
| 80053 |
Comprehensive metabolic panel |
145 |
137 |
$417.78 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,025 |
955 |
$376.90 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
61 |
55 |
$367.36 |
| 99441 |
|
717 |
682 |
$352.47 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
167 |
156 |
$313.39 |
| 90734 |
|
365 |
352 |
$305.56 |
| 90723 |
|
108 |
101 |
$232.16 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
174 |
159 |
$205.83 |
| 90696 |
|
147 |
132 |
$188.70 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$178.92 |
| 90680 |
|
186 |
171 |
$169.61 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
34 |
31 |
$161.30 |
| 90657 |
|
34 |
34 |
$132.00 |
| 84439 |
|
48 |
46 |
$117.84 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
75 |
72 |
$116.38 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
873 |
837 |
$111.07 |
| 81001 |
|
136 |
129 |
$110.72 |
| 90744 |
|
20 |
20 |
$80.00 |
| 86592 |
|
55 |
51 |
$74.56 |
| 90686 |
|
1,232 |
1,204 |
$71.42 |
| 82274 |
|
19 |
17 |
$69.36 |
| 83001 |
|
14 |
12 |
$60.75 |
| 84153 |
|
19 |
17 |
$60.15 |
| 96127 |
|
598 |
593 |
$53.52 |
| 93000 |
|
271 |
257 |
$51.00 |
| 82607 |
|
13 |
13 |
$49.29 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
25 |
24 |
$46.10 |
| 92015 |
Determination of refractive state |
17 |
17 |
$41.40 |
| 0081A |
|
17 |
17 |
$40.00 |
| 99443 |
|
80 |
76 |
$40.00 |
| 87088 |
|
23 |
22 |
$35.28 |
| 82570 |
|
26 |
24 |
$22.56 |
| 86803 |
|
16 |
14 |
$20.22 |
| 82043 |
|
28 |
26 |
$18.90 |
| 90732 |
|
89 |
84 |
$12.57 |
| 90651 |
|
534 |
515 |
$1.96 |
| 90700 |
|
29 |
28 |
$0.28 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,226 |
1,168 |
$0.01 |
| 1160F |
|
8,949 |
8,283 |
$0.00 |
| 1159F |
|
9,549 |
8,845 |
$0.00 |
| 3078F |
|
5,870 |
5,534 |
$0.00 |
| 4035F |
|
4,066 |
3,730 |
$0.00 |
| 90671 |
|
60 |
60 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
399 |
397 |
$0.00 |
| 3077F |
|
1,145 |
1,105 |
$0.00 |
| 0124A |
|
27 |
27 |
$0.00 |
| 3725F |
|
1,220 |
1,190 |
$0.00 |
| 91300 |
|
581 |
569 |
$0.00 |
| 91308 |
|
16 |
16 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
233 |
213 |
$0.00 |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
33 |
30 |
$0.00 |
| 99173 |
|
20 |
20 |
$0.00 |
| G9744 |
Patient not eligible due to active diagnosis of hypertension |
120 |
114 |
$0.00 |
| 91312 |
|
27 |
27 |
$0.00 |
| 4013F |
|
44 |
43 |
$0.00 |
| 90785 |
|
14 |
13 |
$0.00 |
| 2028F |
|
12 |
12 |
$0.00 |
| 3075F |
|
939 |
910 |
$0.00 |
| 1125F |
|
1,808 |
1,724 |
$0.00 |
| 3017F |
|
98 |
97 |
$0.00 |
| 3008F |
|
9,948 |
9,264 |
$0.00 |
| 3074F |
|
5,679 |
5,318 |
$0.00 |
| 1126F |
|
7,048 |
6,632 |
$0.00 |
| 4010F |
|
190 |
188 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
281 |
277 |
$0.00 |
| 1030F |
|
1,916 |
1,811 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
49 |
48 |
$0.00 |
| 3079F |
|
1,722 |
1,655 |
$0.00 |
| 3048F |
|
70 |
70 |
$0.00 |
| 90677 |
|
130 |
128 |
$0.00 |
| 1170F |
|
40 |
40 |
$0.00 |
| 1034F |
|
64 |
64 |
$0.00 |
| 91305 |
|
84 |
70 |
$0.00 |
| 3049F |
|
17 |
17 |
$0.00 |
| 3080F |
|
88 |
88 |
$0.00 |
| 91306 |
|
48 |
48 |
$0.00 |
| 91307 |
|
291 |
283 |
$0.00 |
| 90619 |
|
100 |
100 |
$0.00 |
| 3044F |
|
69 |
69 |
$0.00 |
| 90697 |
|
12 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
165 |
158 |
$0.00 |
| 1022F |
|
17 |
17 |
$0.00 |