| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,090 |
21,550 |
$630K |
| 99199 |
Unlisted special service, procedure or report |
130,402 |
119,973 |
$629K |
| D1110 |
Prophylaxis - adult |
12,278 |
10,872 |
$462K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,724 |
4,070 |
$436K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,696 |
4,726 |
$386K |
| D1120 |
Prophylaxis - child |
13,769 |
12,353 |
$384K |
| D1206 |
Topical application of fluoride varnish |
23,345 |
20,780 |
$375K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,498 |
2,417 |
$338K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,728 |
2,029 |
$263K |
| D1351 |
Sealant - per tooth |
8,118 |
1,922 |
$221K |
| D0330 |
Panoramic radiographic image |
2,832 |
2,482 |
$170K |
| D0274 |
Bitewings - four radiographic images |
4,961 |
4,399 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,000 |
1,376 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,825 |
3,220 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,697 |
1,124 |
$144K |
| D0272 |
Bitewings - two radiographic images |
6,906 |
6,224 |
$131K |
| D2140 |
|
1,517 |
1,123 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
2,285 |
1,952 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,416 |
1,193 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,127 |
865 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,662 |
3,174 |
$54K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,981 |
3,826 |
$51K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,601 |
1,274 |
$36K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
403 |
347 |
$34K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
310 |
253 |
$27K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,093 |
812 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
170 |
119 |
$26K |
| 0001A |
|
523 |
377 |
$23K |
| 0002A |
|
436 |
303 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
155 |
137 |
$15K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,865 |
1,601 |
$14K |
| 36415 |
Collection of venous blood by venipuncture |
5,271 |
4,353 |
$12K |
| D2331 |
|
118 |
77 |
$10K |
| D0240 |
|
575 |
269 |
$10K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,722 |
1,381 |
$10K |
| D2160 |
|
72 |
59 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
153 |
128 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
79 |
56 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
55 |
38 |
$7K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
211 |
166 |
$6K |
| 0072A |
|
133 |
86 |
$6K |
| 90715 |
|
462 |
333 |
$6K |
| D4355 |
|
78 |
76 |
$5K |
| 0071A |
|
124 |
76 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
58 |
31 |
$4K |
| 86710 |
|
375 |
263 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
48 |
37 |
$4K |
| 85018 |
|
3,164 |
2,533 |
$4K |
| D2332 |
|
38 |
26 |
$4K |
| 87430 |
|
279 |
230 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
133 |
118 |
$3K |
| 99215 |
Prolong outpt/office vis |
19 |
15 |
$2K |
| 83021 |
|
169 |
110 |
$2K |
| 96160 |
|
681 |
578 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
16 |
16 |
$2K |
| 92551 |
|
1,250 |
979 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
206 |
181 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D2330 |
|
30 |
25 |
$2K |
| 81025 |
|
328 |
221 |
$2K |
| 99173 |
|
1,910 |
1,553 |
$1K |
| 0003A |
|
35 |
23 |
$1K |
| 90686 |
|
1,080 |
798 |
$1K |
| 81000 |
|
380 |
336 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
40 |
36 |
$955.78 |
| 0124A |
|
18 |
12 |
$845.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
24 |
$600.58 |
| 90651 |
|
58 |
42 |
$590.78 |
| 90688 |
|
288 |
267 |
$540.00 |
| 96127 |
|
141 |
117 |
$507.37 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
38 |
33 |
$492.30 |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
18 |
$470.16 |
| 90480 |
|
18 |
12 |
$389.84 |
| 90656 |
|
147 |
115 |
$352.99 |
| 90734 |
|
410 |
248 |
$320.44 |
| 91305 |
|
179 |
111 |
$242.13 |
| D1354 |
|
26 |
13 |
$188.50 |
| 90670 |
|
25 |
24 |
$161.10 |
| 84443 |
Thyroid stimulating hormone (TSH) |
651 |
619 |
$131.60 |
| 86580 |
|
16 |
13 |
$99.66 |
| 81003 |
|
82 |
57 |
$94.08 |
| 80053 |
Comprehensive metabolic panel |
862 |
823 |
$75.18 |
| 90707 |
|
31 |
30 |
$74.97 |
| 81002 |
|
19 |
13 |
$58.62 |
| 91300 |
|
1,073 |
699 |
$57.75 |
| 96161 |
|
16 |
12 |
$52.36 |
| 80061 |
Lipid panel |
444 |
425 |
$41.04 |
| 90658 |
|
275 |
256 |
$22.00 |
| 99000 |
|
2,408 |
2,142 |
$3.27 |
| 36416 |
|
3,079 |
2,461 |
$0.00 |
| 91307 |
|
288 |
172 |
$0.00 |
| 86592 |
|
18 |
12 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
88 |
71 |
$0.00 |
| 91301 |
|
34 |
26 |
$0.00 |
| 82607 |
|
12 |
12 |
$0.00 |
| G9226 |
Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
13 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
17 |
16 |
$0.00 |
| 90716 |
|
18 |
17 |
$0.00 |
| D1353 |
|
30 |
16 |
$0.00 |
| D0350 |
|
199 |
196 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
105 |
87 |
$0.00 |
| D9996 |
|
233 |
229 |
$0.00 |
| 91312 |
|
21 |
13 |
$0.00 |
| D0191 |
|
523 |
514 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| D1999 |
|
54 |
52 |
$0.00 |
| 86689 |
|
93 |
77 |
$0.00 |
| 90713 |
|
15 |
14 |
$0.00 |
| 90700 |
|
16 |
15 |
$0.00 |