| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
577,665 |
533,996 |
$2.99M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,809 |
7,897 |
$831K |
| 59426 |
|
824 |
697 |
$657K |
| 99215 |
Prolong outpt/office vis |
2,909 |
2,627 |
$444K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,092 |
2,938 |
$427K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
2,944 |
2,483 |
$308K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
6,695 |
5,882 |
$239K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
8,679 |
7,227 |
$233K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
3,721 |
3,434 |
$170K |
| 76801 |
|
1,298 |
1,117 |
$131K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
933 |
847 |
$117K |
| 59430 |
|
831 |
764 |
$92K |
| 0001A |
|
1,872 |
1,700 |
$76K |
| 0002A |
|
1,583 |
1,451 |
$70K |
| D1351 |
Sealant - per tooth |
2,243 |
440 |
$56K |
| 90715 |
|
2,322 |
2,026 |
$54K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,492 |
3,820 |
$52K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
577 |
460 |
$48K |
| 81025 |
|
7,427 |
6,067 |
$48K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,879 |
1,580 |
$44K |
| 86592 |
|
8,746 |
7,667 |
$39K |
| T1002 |
Rn services, up to 15 minutes |
1,705 |
1,459 |
$36K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
328 |
300 |
$32K |
| 85018 |
|
11,953 |
10,395 |
$32K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
461 |
325 |
$28K |
| 36415 |
Collection of venous blood by venipuncture |
11,249 |
9,435 |
$27K |
| 99502 |
|
473 |
454 |
$27K |
| 81003 |
|
10,128 |
6,414 |
$26K |
| 96127 |
|
5,289 |
4,612 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
460 |
$21K |
| 99201 |
|
304 |
289 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
109 |
$20K |
| D1120 |
Prophylaxis - child |
725 |
687 |
$19K |
| 99501 |
|
346 |
331 |
$19K |
| 82950 |
|
3,325 |
2,962 |
$19K |
| 59025 |
Fetal non-stress test |
1,583 |
675 |
$18K |
| 87210 |
|
4,305 |
3,674 |
$17K |
| 99401 |
|
833 |
580 |
$17K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
1,414 |
1,201 |
$17K |
| 82120 |
|
4,240 |
3,678 |
$16K |
| D0330 |
Panoramic radiographic image |
234 |
231 |
$14K |
| 97803 |
|
868 |
741 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
725 |
687 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
693 |
$11K |
| 0003A |
|
279 |
251 |
$10K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
732 |
548 |
$10K |
| D0272 |
Bitewings - two radiographic images |
539 |
506 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
78 |
70 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
732 |
688 |
$9K |
| 90716 |
|
235 |
207 |
$8K |
| 97802 |
|
389 |
332 |
$7K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
668 |
513 |
$7K |
| 82951 |
|
487 |
430 |
$7K |
| 90686 |
|
1,664 |
1,425 |
$5K |
| 0012A |
|
133 |
133 |
$5K |
| 82947 |
|
1,172 |
576 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
408 |
335 |
$4K |
| 90651 |
|
322 |
277 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
142 |
127 |
$4K |
| 99205 |
Prolong outpt/office vis |
15 |
14 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
61 |
58 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
107 |
105 |
$3K |
| 81001 |
|
702 |
576 |
$3K |
| 0013A |
|
61 |
54 |
$3K |
| 82952 |
|
518 |
447 |
$2K |
| 90734 |
|
663 |
549 |
$2K |
| 90707 |
|
138 |
121 |
$2K |
| 90620 |
|
101 |
81 |
$1K |
| 90688 |
|
390 |
357 |
$1K |
| 0011A |
|
252 |
235 |
$1K |
| 90619 |
|
271 |
230 |
$833.70 |
| 81015 |
|
308 |
207 |
$788.40 |
| 86803 |
|
45 |
35 |
$765.53 |
| 86580 |
|
250 |
185 |
$264.68 |
| 90656 |
|
196 |
185 |
$258.65 |
| 87070 |
|
17 |
16 |
$153.30 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
21 |
18 |
$105.27 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
21 |
18 |
$105.27 |
| 91300 |
|
3,637 |
3,025 |
$70.78 |
| 90713 |
|
34 |
27 |
$43.14 |
| 99001 |
|
5,074 |
4,358 |
$0.00 |
| 90633 |
|
151 |
141 |
$0.00 |
| LU240 |
|
12 |
12 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
709 |
661 |
$0.00 |
| 90744 |
|
27 |
27 |
$0.00 |
| 91301 |
|
362 |
317 |
$0.00 |
| LU239 |
|
118 |
97 |
$0.00 |
| 91307 |
|
37 |
31 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
96 |
58 |
$0.00 |
| 92587 |
|
36 |
28 |
$0.00 |