| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,580 |
12,371 |
$967K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,646 |
6,972 |
$749K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,815 |
2,242 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,620 |
2,571 |
$156K |
| D0140 |
Limited oral evaluation - problem focused |
3,012 |
2,820 |
$154K |
| D1110 |
Prophylaxis - adult |
2,222 |
2,185 |
$135K |
| D1206 |
Topical application of fluoride varnish |
5,887 |
5,697 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
2,745 |
2,691 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,757 |
1,335 |
$97K |
| D4342 |
|
988 |
751 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,466 |
1,434 |
$67K |
| D1120 |
Prophylaxis - child |
1,458 |
1,433 |
$65K |
| D4355 |
|
835 |
794 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,218 |
3,080 |
$49K |
| D4341 |
|
503 |
439 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,916 |
1,883 |
$41K |
| 90832 |
Psychotherapy, 30 minutes with patient |
523 |
415 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,231 |
939 |
$29K |
| D4910 |
|
491 |
469 |
$24K |
| 98968 |
|
442 |
384 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
82 |
$19K |
| 99442 |
|
211 |
208 |
$17K |
| D9995 |
|
383 |
376 |
$12K |
| 98967 |
|
316 |
295 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
114 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
532 |
524 |
$8K |
| 96156 |
|
80 |
73 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
98 |
95 |
$5K |
| D1351 |
Sealant - per tooth |
162 |
52 |
$5K |
| 96158 |
|
99 |
80 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
52 |
52 |
$4K |
| D0270 |
|
383 |
378 |
$3K |
| 90661 |
|
95 |
94 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
25 |
25 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
17 |
16 |
$2K |
| T1016 |
Case management, each 15 minutes |
44 |
40 |
$2K |
| 90674 |
|
99 |
94 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
44 |
39 |
$2K |
| 0012A |
|
135 |
134 |
$2K |
| 0004A |
|
38 |
38 |
$1K |
| D2331 |
|
16 |
12 |
$1K |
| 99402 |
|
58 |
49 |
$1K |
| 99441 |
|
16 |
16 |
$1K |
| D0191 |
|
48 |
47 |
$936.96 |
| 90677 |
|
14 |
14 |
$840.84 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
154 |
152 |
$833.71 |
| 98966 |
|
57 |
55 |
$723.50 |
| 36416 |
|
203 |
196 |
$666.75 |
| 0124A |
|
18 |
18 |
$640.00 |
| 0002A |
|
14 |
14 |
$560.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$522.58 |
| 0011A |
|
57 |
57 |
$514.32 |
| 0064A |
|
12 |
12 |
$480.00 |
| 0134A |
|
14 |
14 |
$480.00 |
| 99422 |
|
16 |
16 |
$434.88 |
| D1354 |
|
47 |
14 |
$321.15 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
16 |
16 |
$188.81 |
| 99401 |
|
12 |
12 |
$173.60 |
| D0603 |
|
3,894 |
3,811 |
$0.01 |
| D1310 |
|
12,793 |
12,062 |
$0.00 |
| D1330 |
|
15,605 |
14,478 |
$0.00 |
| D0602 |
|
544 |
542 |
$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 |
168 |
145 |
$0.00 |
| 91307 |
|
13 |
13 |
$0.00 |
| 91306 |
|
12 |
12 |
$0.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
28 |
25 |
$0.00 |
| 91313 |
|
14 |
14 |
$0.00 |
| 91312 |
|
19 |
19 |
$0.00 |