| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,244 |
8,847 |
$299K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
854 |
845 |
$59K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
828 |
806 |
$57K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
980 |
893 |
$39K |
| D1120 |
Prophylaxis - child |
621 |
610 |
$32K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
361 |
356 |
$25K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,202 |
3,143 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
640 |
640 |
$15K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,904 |
1,863 |
$15K |
| 99215 |
Prolong outpt/office vis |
227 |
172 |
$10K |
| D1206 |
Topical application of fluoride varnish |
771 |
760 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
135 |
135 |
$9K |
| D1351 |
Sealant - per tooth |
681 |
190 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
115 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
157 |
151 |
$4K |
| D0191 |
|
321 |
319 |
$3K |
| 81025 |
|
346 |
325 |
$3K |
| 90686 |
|
448 |
441 |
$2K |
| D1330 |
|
870 |
859 |
$2K |
| 99403 |
|
43 |
39 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
264 |
259 |
$2K |
| 90670 |
|
285 |
279 |
$2K |
| 90473 |
|
174 |
174 |
$1K |
| D0274 |
Bitewings - four radiographic images |
92 |
91 |
$979.32 |
| H1000 |
Prenatal care, at-risk assessment |
19 |
12 |
$884.00 |
| D1354 |
|
183 |
63 |
$640.54 |
| 81002 |
|
350 |
334 |
$570.29 |
| D0220 |
Intraoral - periapical first radiographic image |
138 |
134 |
$454.68 |
| 85018 |
|
378 |
376 |
$414.11 |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
128 |
$412.22 |
| 90633 |
|
61 |
61 |
$353.00 |
| 90672 |
|
110 |
110 |
$195.12 |
| 90696 |
|
13 |
13 |
$186.94 |
| 90734 |
|
15 |
12 |
$170.44 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
26 |
26 |
$169.03 |
| 90715 |
|
83 |
80 |
$158.97 |
| 90710 |
|
14 |
14 |
$146.62 |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
97 |
$119.24 |
| 3074F |
|
267 |
246 |
$107.37 |
| 90698 |
|
13 |
13 |
$90.00 |
| 90680 |
|
50 |
50 |
$22.00 |
| D0190 |
|
28 |
28 |
$13.52 |
| 1126F |
|
157 |
140 |
$0.00 |
| 90656 |
|
15 |
15 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
46 |
44 |
$0.00 |
| 3079F |
|
45 |
40 |
$0.00 |
| 1111F |
|
32 |
29 |
$0.00 |
| 90660 |
|
36 |
36 |
$0.00 |
| 1125F |
|
28 |
27 |
$0.00 |
| 1170F |
|
69 |
65 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 1160F |
|
378 |
348 |
$0.00 |
| 1159F |
|
319 |
293 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
353 |
301 |
$0.00 |
| 90671 |
|
14 |
13 |
$0.00 |
| 3078F |
|
115 |
103 |
$0.00 |
| D9996 |
|
19 |
19 |
$0.00 |