| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,774 |
5,319 |
$167K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,943 |
2,732 |
$132K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
1,337 |
1,020 |
$116K |
| D1120 |
Prophylaxis - child |
2,910 |
2,907 |
$95K |
| D0330 |
Panoramic radiographic image |
1,850 |
1,844 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,181 |
1,038 |
$65K |
| D1110 |
Prophylaxis - adult |
1,537 |
1,535 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,411 |
1,128 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
4,234 |
4,224 |
$44K |
| D1351 |
Sealant - per tooth |
3,583 |
1,160 |
$36K |
| D0602 |
|
1,805 |
1,796 |
$30K |
| D0274 |
Bitewings - four radiographic images |
2,664 |
2,660 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,627 |
1,623 |
$26K |
| D0603 |
|
2,078 |
2,075 |
$25K |
| D1206 |
Topical application of fluoride varnish |
5,227 |
5,220 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
2,200 |
2,168 |
$23K |
| 92552 |
|
930 |
923 |
$16K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,169 |
1,158 |
$16K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
211 |
211 |
$15K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
151 |
151 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
154 |
151 |
$11K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
115 |
107 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
85 |
78 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,379 |
2,365 |
$5K |
| D1330 |
|
4,817 |
4,808 |
$5K |
| 87428 |
|
167 |
164 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
3,777 |
3,705 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
83 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$3K |
| 99406 |
|
683 |
572 |
$3K |
| D0601 |
|
145 |
145 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,551 |
2,485 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
27 |
26 |
$2K |
| D1310 |
|
3,938 |
3,931 |
$2K |
| 99215 |
Prolong outpt/office vis |
37 |
34 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
98 |
96 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
279 |
275 |
$2K |
| 90461 |
|
417 |
405 |
$1K |
| 90671 |
|
14 |
14 |
$1K |
| D3120 |
|
376 |
341 |
$548.20 |
| 85018 |
|
369 |
365 |
$362.50 |
| D1354 |
|
112 |
39 |
$336.58 |
| D0270 |
|
282 |
279 |
$219.33 |
| 3074F |
|
123 |
117 |
$175.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$120.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
15 |
$80.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
28 |
27 |
$57.57 |
| 99173 |
|
113 |
107 |
$13.09 |
| D1320 |
|
1,055 |
1,037 |
$0.00 |
| 96127 |
|
133 |
112 |
$0.00 |
| 90686 |
|
98 |
98 |
$0.00 |
| 3008F |
|
800 |
774 |
$0.00 |
| 90656 |
|
86 |
85 |
$0.00 |
| 90651 |
|
44 |
44 |
$0.00 |
| 90647 |
|
26 |
25 |
$0.00 |
| 99177 |
|
1,108 |
1,008 |
$0.00 |
| 3078F |
|
53 |
51 |
$0.00 |
| 90734 |
|
38 |
36 |
$0.00 |
| D9910 |
|
45 |
39 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
42 |
41 |
$0.00 |