| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,714 |
7,015 |
$721K |
| D1110 |
Prophylaxis - adult |
9,034 |
8,038 |
$564K |
| D0120 |
Periodic oral evaluation - established patient |
10,398 |
8,871 |
$385K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,164 |
1,901 |
$237K |
| D9920 |
|
4,261 |
1,602 |
$237K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,449 |
1,392 |
$149K |
| D0274 |
Bitewings - four radiographic images |
4,060 |
3,757 |
$141K |
| 11721 |
|
1,406 |
1,233 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
5,886 |
5,498 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
5,652 |
5,105 |
$106K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,133 |
1,077 |
$104K |
| D9997 |
|
1,535 |
512 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
968 |
856 |
$77K |
| D0330 |
Panoramic radiographic image |
1,575 |
1,393 |
$70K |
| D1120 |
Prophylaxis - child |
954 |
933 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
311 |
$47K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
422 |
421 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,350 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
1,346 |
1,316 |
$44K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
330 |
330 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,892 |
1,420 |
$34K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,021 |
897 |
$17K |
| 11720 |
|
205 |
157 |
$17K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
421 |
384 |
$16K |
| D2335 |
|
74 |
54 |
$10K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
100 |
100 |
$10K |
| D2331 |
|
83 |
70 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
56 |
$8K |
| D3320 |
|
13 |
13 |
$7K |
| D0272 |
Bitewings - two radiographic images |
219 |
179 |
$6K |
| 99442 |
|
183 |
181 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
516 |
503 |
$5K |
| 90756 |
|
183 |
183 |
$5K |
| D2330 |
|
57 |
44 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
142 |
121 |
$3K |
| D1999 |
|
51 |
32 |
$3K |
| D0270 |
|
181 |
175 |
$3K |
| D2332 |
|
25 |
12 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
95 |
94 |
$1K |
| G0008 |
Administration of influenza virus vaccine |
82 |
82 |
$1K |
| D9430 |
|
18 |
16 |
$998.45 |
| H0049 |
Alcohol and/or drug screening |
21 |
21 |
$754.30 |
| Q2037 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) |
16 |
16 |
$459.04 |
| D4355 |
|
31 |
31 |
$125.80 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
639 |
573 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
409 |
371 |
$0.00 |