| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,927 |
7,664 |
$252K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
791 |
687 |
$46K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,042 |
910 |
$40K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
715 |
515 |
$32K |
| 99401 |
|
2,255 |
2,005 |
$23K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
392 |
330 |
$22K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
446 |
339 |
$20K |
| D0330 |
Panoramic radiographic image |
693 |
573 |
$12K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
133 |
121 |
$9K |
| D1330 |
|
1,536 |
1,228 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
438 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
261 |
225 |
$7K |
| D1110 |
Prophylaxis - adult |
560 |
433 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
760 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
475 |
303 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
927 |
747 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
498 |
394 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
761 |
670 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
65 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
41 |
$2K |
| 99383 |
|
30 |
26 |
$2K |
| H1000 |
Prenatal care, at-risk assessment |
54 |
25 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
370 |
320 |
$2K |
| 81025 |
|
896 |
788 |
$2K |
| 90671 |
|
16 |
14 |
$2K |
| 90670 |
|
142 |
125 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
14 |
13 |
$979.11 |
| 99381 |
|
15 |
13 |
$964.58 |
| 99384 |
|
21 |
12 |
$898.34 |
| 90461 |
|
540 |
321 |
$867.45 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
19 |
15 |
$800.49 |
| D1206 |
Topical application of fluoride varnish |
1,053 |
784 |
$780.39 |
| 83655 |
|
174 |
167 |
$695.17 |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
797 |
$577.56 |
| D0120 |
Periodic oral evaluation - established patient |
159 |
131 |
$493.21 |
| 3074F |
|
5,940 |
5,154 |
$400.00 |
| 99385 |
|
20 |
14 |
$392.53 |
| D1120 |
Prophylaxis - child |
28 |
28 |
$371.82 |
| 82962 |
|
869 |
695 |
$370.78 |
| D0274 |
Bitewings - four radiographic images |
137 |
118 |
$350.28 |
| D0191 |
|
454 |
297 |
$292.35 |
| 90651 |
|
123 |
114 |
$287.31 |
| 85018 |
|
633 |
595 |
$279.41 |
| 90686 |
|
269 |
258 |
$235.12 |
| 36415 |
Collection of venous blood by venipuncture |
577 |
549 |
$234.36 |
| D0190 |
|
31 |
28 |
$229.09 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
29 |
24 |
$109.23 |
| 81003 |
|
255 |
210 |
$92.04 |
| 90647 |
|
39 |
39 |
$80.00 |
| 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 |
191 |
124 |
$73.42 |
| 99406 |
|
13 |
13 |
$50.21 |
| D0603 |
|
390 |
316 |
$25.00 |
| 90633 |
|
14 |
14 |
$20.00 |
| 90681 |
|
12 |
12 |
$20.00 |
| 4035F |
|
34 |
30 |
$15.74 |
| 1160F |
|
8,030 |
6,912 |
$12.07 |
| D0601 |
|
18 |
17 |
$10.00 |
| 1000F |
|
6,696 |
5,829 |
$9.93 |
| 1159F |
|
8,014 |
6,890 |
$9.93 |
| 96127 |
|
240 |
225 |
$5.07 |
| 3008F |
|
11,768 |
9,538 |
$2.02 |
| 3079F |
|
1,973 |
1,656 |
$0.00 |
| 2000F |
|
10,164 |
8,566 |
$0.00 |
| 3044F |
|
1,131 |
995 |
$0.00 |
| 2010F |
|
4,626 |
4,083 |
$0.00 |
| 2001F |
|
12,458 |
10,527 |
$0.00 |
| 36416 |
|
413 |
304 |
$0.00 |
| 1220F |
|
4,674 |
4,028 |
$0.00 |
| 3080F |
|
124 |
89 |
$0.00 |
| 4037F |
|
111 |
110 |
$0.00 |
| 3075F |
|
580 |
510 |
$0.00 |
| 4000F |
|
2,230 |
1,979 |
$0.00 |
| 1036F |
|
1,465 |
1,296 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
97 |
87 |
$0.00 |
| 4010F |
|
188 |
128 |
$0.00 |
| 1126F |
|
2,175 |
1,881 |
$0.00 |
| 1125F |
|
190 |
172 |
$0.00 |
| 1055F |
|
535 |
503 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 92551 |
|
283 |
271 |
$0.00 |
| 1157F |
|
345 |
110 |
$0.00 |
| D1310 |
|
278 |
191 |
$0.00 |
| 3351F |
|
54 |
53 |
$0.00 |
| 3048F |
|
25 |
14 |
$0.00 |
| 92587 |
|
234 |
28 |
$0.00 |
| 4050F |
|
14 |
13 |
$0.00 |
| D0602 |
|
130 |
86 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 90620 |
|
43 |
38 |
$0.00 |
| D4999 |
|
223 |
223 |
$0.00 |
| 90744 |
|
14 |
14 |
$0.00 |
| 3353F |
|
21 |
20 |
$0.00 |
| 3078F |
|
5,106 |
4,269 |
$0.00 |
| 99173 |
|
982 |
691 |
$0.00 |
| 3077F |
|
372 |
259 |
$0.00 |
| 2028F |
|
121 |
119 |
$0.00 |
| 90734 |
|
16 |
15 |
$0.00 |
| 3210F |
|
44 |
36 |
$0.00 |
| D0270 |
|
34 |
33 |
$0.00 |
| 3280F |
|
13 |
13 |
$0.00 |
| 90710 |
|
32 |
26 |
$0.00 |
| 3725F |
|
14 |
12 |
$0.00 |
| 90715 |
|
16 |
12 |
$0.00 |