| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
9,578 |
8,936 |
$755K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,747 |
5,239 |
$313K |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,050 |
1,487 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
941 |
542 |
$56K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
544 |
515 |
$52K |
| D1110 |
Prophylaxis - adult |
1,004 |
992 |
$39K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
338 |
319 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,046 |
856 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
478 |
459 |
$24K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
662 |
535 |
$24K |
| D4355 |
|
231 |
229 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
166 |
$18K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
231 |
224 |
$17K |
| D0330 |
Panoramic radiographic image |
380 |
349 |
$16K |
| 59425 |
|
27 |
26 |
$14K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
908 |
851 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,098 |
872 |
$13K |
| 90674 |
|
413 |
394 |
$12K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,539 |
1,470 |
$10K |
| 90715 |
|
326 |
302 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
54 |
$8K |
| 59430 |
|
40 |
39 |
$8K |
| 90686 |
|
503 |
473 |
$8K |
| 99385 |
|
73 |
73 |
$7K |
| 0012A |
|
211 |
193 |
$6K |
| D0274 |
Bitewings - four radiographic images |
236 |
236 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
340 |
333 |
$5K |
| 0064A |
|
145 |
134 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,117 |
1,063 |
$4K |
| 0011A |
|
224 |
198 |
$3K |
| 0134A |
|
104 |
95 |
$3K |
| 0502F |
|
200 |
161 |
$3K |
| 90661 |
|
144 |
142 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
27 |
27 |
$2K |
| 99215 |
Prolong outpt/office vis |
15 |
15 |
$2K |
| 81025 |
|
283 |
268 |
$2K |
| 86803 |
|
154 |
149 |
$2K |
| D9994 |
|
256 |
246 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
99 |
$1K |
| 90633 |
|
45 |
43 |
$1K |
| 99386 |
|
14 |
14 |
$886.06 |
| 99406 |
|
131 |
115 |
$798.93 |
| D4346 |
|
13 |
13 |
$797.55 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
156 |
149 |
$785.35 |
| 90832 |
Psychotherapy, 30 minutes with patient |
13 |
12 |
$684.84 |
| 90651 |
|
14 |
14 |
$614.00 |
| 99441 |
|
14 |
12 |
$541.97 |
| 90713 |
|
34 |
32 |
$517.00 |
| 36415 |
Collection of venous blood by venipuncture |
238 |
224 |
$516.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
77 |
12 |
$447.20 |
| D9992 |
|
33 |
33 |
$355.08 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$228.69 |
| 81002 |
|
73 |
67 |
$183.71 |
| 82962 |
|
74 |
61 |
$144.72 |
| 99072 |
|
3,183 |
2,995 |
$75.58 |
| D1310 |
|
150 |
149 |
$0.00 |
| D1330 |
|
219 |
214 |
$0.00 |
| D4342 |
|
53 |
16 |
$0.00 |