| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29,659 |
26,516 |
$5.12M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12,563 |
11,355 |
$2.11M |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
9,433 |
8,735 |
$1.66M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
8,478 |
7,899 |
$1.57M |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
5,643 |
5,239 |
$1.03M |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,763 |
2,486 |
$490K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,089 |
1,914 |
$363K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,597 |
1,404 |
$285K |
| 99381 |
|
300 |
279 |
$52K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
263 |
245 |
$45K |
| D1120 |
Prophylaxis - child |
587 |
563 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
303 |
259 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
434 |
420 |
$23K |
| D1206 |
Topical application of fluoride varnish |
686 |
647 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15,346 |
14,054 |
$21K |
| 92551 |
|
12,105 |
11,057 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
31 |
$11K |
| 87430 |
|
5,650 |
5,215 |
$11K |
| D1351 |
Sealant - per tooth |
165 |
45 |
$10K |
| D0272 |
Bitewings - two radiographic images |
199 |
190 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
299 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
95 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
8,112 |
7,648 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
16,625 |
9,103 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
221 |
207 |
$6K |
| 90686 |
|
1,581 |
1,393 |
$6K |
| 87428 |
|
1,316 |
1,174 |
$6K |
| 90677 |
|
828 |
822 |
$5K |
| 36416 |
|
7,988 |
7,251 |
$5K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
1,343 |
1,263 |
$3K |
| 87400 |
|
659 |
618 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
20 |
19 |
$3K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
515 |
487 |
$3K |
| 99173 |
|
8,313 |
7,521 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,557 |
1,469 |
$2K |
| 85018 |
|
5,422 |
4,929 |
$2K |
| 90651 |
|
28 |
25 |
$2K |
| 90723 |
|
681 |
677 |
$1K |
| D0190 |
|
27 |
26 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
15 |
15 |
$1K |
| 90633 |
|
244 |
224 |
$821.47 |
| 83655 |
|
186 |
151 |
$799.52 |
| 90647 |
|
503 |
495 |
$578.00 |
| 3008F |
|
14,466 |
13,119 |
$556.51 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
78 |
71 |
$339.45 |
| 0002A |
|
13 |
13 |
$260.00 |
| 90688 |
|
15 |
14 |
$225.36 |
| 90700 |
|
28 |
25 |
$220.12 |
| 1000F |
|
47 |
45 |
$195.20 |
| 3725F |
|
2,279 |
2,147 |
$178.99 |
| 90474 |
|
779 |
737 |
$175.50 |
| 90680 |
|
13 |
13 |
$111.68 |
| 90734 |
|
30 |
27 |
$81.60 |
| 87280 |
|
160 |
155 |
$46.95 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
12 |
$34.00 |
| 90461 |
|
109 |
56 |
$32.50 |
| 81003 |
|
45 |
38 |
$3.16 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,478 |
1,429 |
$0.00 |
| 3074F |
|
1,700 |
1,549 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
179 |
171 |
$0.00 |
| 90716 |
|
30 |
30 |
$0.00 |
| 99070 |
|
13 |
12 |
$0.00 |
| 90681 |
|
166 |
166 |
$0.00 |
| 90473 |
|
664 |
630 |
$0.00 |
| 3078F |
|
1,672 |
1,529 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
217 |
210 |
$0.00 |
| 81025 |
|
12 |
12 |
$0.00 |
| 90707 |
|
30 |
30 |
$0.00 |
| 90671 |
|
52 |
50 |
$0.00 |