| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
3,909 |
3,415 |
$397K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,117 |
3,553 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,179 |
970 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
785 |
749 |
$40K |
| D1120 |
Prophylaxis - child |
490 |
461 |
$35K |
| D1110 |
Prophylaxis - adult |
483 |
467 |
$32K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
476 |
435 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
721 |
685 |
$29K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
529 |
444 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
147 |
126 |
$24K |
| D1351 |
Sealant - per tooth |
529 |
228 |
$22K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,635 |
2,476 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
160 |
$18K |
| D0274 |
Bitewings - four radiographic images |
369 |
352 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,582 |
1,499 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
567 |
473 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
390 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
192 |
$11K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
908 |
851 |
$9K |
| D0190 |
|
419 |
384 |
$8K |
| 59410 |
|
12 |
12 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
82 |
79 |
$6K |
| 59025 |
Fetal non-stress test |
347 |
180 |
$5K |
| 99188 |
|
329 |
315 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
64 |
58 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
71 |
60 |
$4K |
| D2330 |
|
41 |
37 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
112 |
85 |
$3K |
| D0272 |
Bitewings - two radiographic images |
483 |
455 |
$2K |
| D1354 |
|
265 |
204 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,430 |
1,354 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
982 |
935 |
$1K |
| D1330 |
|
1,089 |
1,041 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$869.08 |
| 90670 |
|
114 |
112 |
$499.15 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
49 |
26 |
$384.76 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$300.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
20 |
20 |
$154.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$119.04 |
| 90686 |
|
248 |
238 |
$90.00 |
| 81003 |
|
51 |
33 |
$89.42 |
| 90651 |
|
20 |
20 |
$50.00 |
| 3008F |
|
10,460 |
8,973 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
960 |
942 |
$0.00 |
| 1000F |
|
1,381 |
1,038 |
$0.00 |
| 1036F |
|
694 |
533 |
$0.00 |
| 92551 |
|
2,054 |
1,867 |
$0.00 |
| 1111F |
|
183 |
134 |
$0.00 |
| 0513F |
|
178 |
110 |
$0.00 |
| 3074F |
|
645 |
575 |
$0.00 |
| 1126F |
|
88 |
53 |
$0.00 |
| 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 |
71 |
51 |
$0.00 |
| 90697 |
|
14 |
14 |
$0.00 |
| 90656 |
|
31 |
31 |
$0.00 |
| 90674 |
|
13 |
12 |
$0.00 |
| 3079F |
|
96 |
73 |
$0.00 |
| 3351F |
|
22 |
13 |
$0.00 |
| 3352F |
|
14 |
14 |
$0.00 |
| 3017F |
|
12 |
12 |
$0.00 |
| 3078F |
|
497 |
403 |
$0.00 |
| 99173 |
|
2,409 |
2,205 |
$0.00 |
| 3015F |
|
87 |
68 |
$0.00 |
| 3725F |
|
475 |
412 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
271 |
190 |
$0.00 |
| 90633 |
|
26 |
26 |
$0.00 |
| 1160F |
|
86 |
52 |
$0.00 |
| 4004F |
|
226 |
137 |
$0.00 |
| 1159F |
|
98 |
64 |
$0.00 |
| 0502F |
|
58 |
29 |
$0.00 |
| 90655 |
|
12 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$0.00 |
| 1039F |
|
13 |
12 |
$0.00 |