| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,872 |
3,394 |
$143K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
595 |
551 |
$41K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
257 |
241 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,442 |
1,417 |
$18K |
| 90834 |
Psychotherapy, 45 minutes with patient |
344 |
212 |
$16K |
| 90791 |
Psychiatric diagnostic evaluation |
196 |
137 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,053 |
1,023 |
$13K |
| D0330 |
Panoramic radiographic image |
687 |
668 |
$13K |
| D1120 |
Prophylaxis - child |
792 |
781 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
727 |
719 |
$11K |
| D1110 |
Prophylaxis - adult |
630 |
618 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
219 |
$9K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
59 |
25 |
$8K |
| 90832 |
Psychotherapy, 30 minutes with patient |
257 |
171 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
384 |
368 |
$6K |
| 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 |
639 |
516 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
401 |
361 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
87 |
83 |
$5K |
| D0274 |
Bitewings - four radiographic images |
726 |
713 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
140 |
$4K |
| D1330 |
|
1,479 |
1,447 |
$4K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
48 |
37 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
178 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,526 |
884 |
$3K |
| D0272 |
Bitewings - two radiographic images |
375 |
371 |
$3K |
| 87428 |
|
118 |
114 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,288 |
1,224 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
405 |
393 |
$2K |
| 99384 |
|
15 |
13 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
13 |
$934.47 |
| D1351 |
Sealant - per tooth |
82 |
30 |
$817.82 |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$560.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$468.80 |
| 36415 |
Collection of venous blood by venipuncture |
593 |
567 |
$432.53 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
175 |
174 |
$425.25 |
| 81003 |
|
236 |
195 |
$239.16 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
26 |
26 |
$182.92 |
| D0270 |
|
38 |
37 |
$135.04 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
13 |
13 |
$132.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
17 |
$84.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$78.00 |
| D3120 |
|
14 |
12 |
$32.84 |
| 3078F |
|
2,367 |
2,070 |
$0.00 |
| 1160F |
|
2,625 |
2,335 |
$0.00 |
| 3210F |
|
156 |
133 |
$0.00 |
| 1159F |
|
2,657 |
2,365 |
$0.00 |
| 3077F |
|
311 |
295 |
$0.00 |
| 99177 |
|
139 |
127 |
$0.00 |
| 90461 |
|
30 |
28 |
$0.00 |
| 4004F |
|
43 |
42 |
$0.00 |
| 3008F |
|
4,135 |
3,680 |
$0.00 |
| 1000F |
|
3,851 |
3,399 |
$0.00 |
| 2001F |
|
4,586 |
3,929 |
$0.00 |
| 2000F |
|
4,295 |
3,663 |
$0.00 |
| 3079F |
|
1,117 |
1,013 |
$0.00 |
| 4000F |
|
279 |
259 |
$0.00 |
| 1220F |
|
3,801 |
3,109 |
$0.00 |
| 1126F |
|
1,322 |
1,195 |
$0.00 |
| 3074F |
|
2,921 |
2,507 |
$0.00 |
| 3044F |
|
264 |
250 |
$0.00 |
| 3075F |
|
323 |
310 |
$0.00 |
| 92551 |
|
135 |
124 |
$0.00 |
| 3080F |
|
168 |
159 |
$0.00 |
| 1125F |
|
688 |
639 |
$0.00 |
| 36416 |
|
130 |
128 |
$0.00 |
| 3351F |
|
29 |
28 |
$0.00 |
| 1111F |
|
12 |
12 |
$0.00 |
| 1036F |
|
47 |
41 |
$0.00 |
| D1310 |
|
14 |
13 |
$0.00 |