| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33,564 |
22,664 |
$2.15M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,807 |
4,381 |
$326K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,789 |
2,791 |
$305K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
3,090 |
1,289 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,040 |
1,074 |
$145K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,568 |
802 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,061 |
2,380 |
$123K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,543 |
1,150 |
$110K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,580 |
1,045 |
$110K |
| D1110 |
Prophylaxis - adult |
2,099 |
1,568 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,558 |
871 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,495 |
716 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,691 |
2,072 |
$74K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,536 |
2,464 |
$73K |
| D0330 |
Panoramic radiographic image |
1,683 |
1,442 |
$68K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
954 |
677 |
$67K |
| D1120 |
Prophylaxis - child |
1,422 |
1,172 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
2,163 |
1,828 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,874 |
1,543 |
$56K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
4,048 |
3,791 |
$45K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
531 |
371 |
$37K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
477 |
349 |
$34K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
592 |
228 |
$28K |
| 96127 |
|
7,129 |
6,648 |
$26K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
355 |
250 |
$26K |
| 0012A |
|
848 |
848 |
$23K |
| 97162 |
|
317 |
257 |
$23K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
592 |
151 |
$22K |
| 97164 |
|
268 |
113 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
247 |
130 |
$19K |
| 0011A |
|
849 |
848 |
$16K |
| 90686 |
|
1,644 |
1,617 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,142 |
1,112 |
$14K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
281 |
278 |
$14K |
| D4341 |
|
220 |
49 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
799 |
787 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
999 |
932 |
$10K |
| 0064A |
|
302 |
302 |
$9K |
| D1206 |
Topical application of fluoride varnish |
314 |
314 |
$9K |
| 99442 |
|
138 |
116 |
$8K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
127 |
84 |
$8K |
| 36415 |
Collection of venous blood by venipuncture |
1,923 |
1,852 |
$7K |
| 0072A |
|
229 |
229 |
$7K |
| D1351 |
Sealant - per tooth |
135 |
48 |
$6K |
| 0071A |
|
212 |
212 |
$6K |
| 0001A |
|
193 |
193 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
300 |
293 |
$5K |
| 0002A |
|
160 |
160 |
$5K |
| W5000 |
|
57 |
48 |
$4K |
| 97161 |
|
71 |
66 |
$4K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
60 |
57 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
394 |
275 |
$3K |
| 97163 |
|
66 |
59 |
$3K |
| 99441 |
|
43 |
30 |
$3K |
| D2335 |
|
22 |
12 |
$2K |
| 90656 |
|
339 |
331 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
15 |
12 |
$1K |
| 99383 |
|
24 |
12 |
$1K |
| 87430 |
|
155 |
155 |
$822.61 |
| 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 |
14 |
13 |
$468.86 |
| 99000 |
|
486 |
483 |
$439.83 |
| 81002 |
|
93 |
86 |
$323.33 |
| 83655 |
|
25 |
25 |
$306.43 |
| 81025 |
|
111 |
107 |
$237.92 |
| 90461 |
|
164 |
162 |
$220.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$218.29 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$183.30 |
| 87807 |
|
13 |
13 |
$170.30 |
| 3074F |
|
1,057 |
925 |
$146.20 |
| 3079F |
|
145 |
134 |
$143.32 |
| 85018 |
|
36 |
36 |
$66.84 |
| 94760 |
|
13 |
13 |
$16.36 |
| 3078F |
|
800 |
707 |
$2.23 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
3,579 |
3,331 |
$0.00 |
| 90651 |
|
16 |
16 |
$0.00 |
| 90619 |
|
14 |
14 |
$0.00 |
| 90677 |
|
13 |
13 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
2,497 |
2,284 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |