| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,352 |
6,790 |
$312K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,918 |
1,823 |
$124K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,706 |
924 |
$90K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,326 |
1,289 |
$49K |
| 0001A |
|
400 |
399 |
$29K |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
1,111 |
683 |
$22K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
423 |
401 |
$21K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
346 |
341 |
$19K |
| 0002A |
|
317 |
317 |
$17K |
| 0011A |
|
331 |
329 |
$17K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
498 |
465 |
$13K |
| 0012A |
|
304 |
303 |
$11K |
| 99188 |
|
528 |
512 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
372 |
$10K |
| D0330 |
Panoramic radiographic image |
237 |
232 |
$9K |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
290 |
269 |
$9K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
149 |
146 |
$8K |
| 0004A |
|
109 |
104 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
663 |
644 |
$8K |
| 0064A |
|
62 |
62 |
$6K |
| 0071A |
|
65 |
65 |
$6K |
| H1000 |
Prenatal care, at-risk assessment |
98 |
88 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
61 |
$5K |
| D1206 |
Topical application of fluoride varnish |
371 |
364 |
$5K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
50 |
50 |
$5K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
239 |
110 |
$4K |
| 0072A |
|
46 |
46 |
$4K |
| D1120 |
Prophylaxis - child |
237 |
227 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
194 |
100 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
138 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
265 |
263 |
$2K |
| 0031A |
|
33 |
31 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
78 |
$966.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
97 |
97 |
$917.60 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
13 |
12 |
$900.49 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
13 |
$822.54 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$785.56 |
| D1351 |
Sealant - per tooth |
36 |
13 |
$660.00 |
| 87400 |
|
40 |
40 |
$461.04 |
| 36415 |
Collection of venous blood by venipuncture |
215 |
209 |
$452.77 |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
97 |
$390.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
27 |
24 |
$387.22 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$360.00 |
| D0120 |
Periodic oral evaluation - established patient |
16 |
16 |
$273.28 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
24 |
$255.72 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$233.17 |
| 90670 |
|
281 |
273 |
$178.00 |
| 90723 |
|
179 |
174 |
$169.25 |
| 80305 |
|
20 |
17 |
$127.06 |
| D0272 |
Bitewings - two radiographic images |
27 |
25 |
$120.00 |
| 90647 |
|
112 |
109 |
$110.00 |
| 90686 |
|
148 |
143 |
$101.25 |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$100.00 |
| 90633 |
|
29 |
29 |
$55.75 |
| 81003 |
|
12 |
12 |
$25.41 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
395 |
250 |
$15.36 |
| 90681 |
|
25 |
25 |
$12.00 |
| 90685 |
|
20 |
19 |
$12.00 |
| 91300 |
|
43 |
38 |
$0.35 |
| 3074F |
|
1,708 |
1,598 |
$0.00 |
| 97014 |
|
333 |
213 |
$0.00 |
| 3079F |
|
191 |
175 |
$0.00 |
| D9215 |
|
12 |
12 |
$0.00 |
| D0603 |
|
180 |
178 |
$0.00 |
| D1330 |
|
190 |
183 |
$0.00 |
| D1310 |
|
188 |
181 |
$0.00 |
| 4004F |
|
14 |
12 |
$0.00 |
| 3078F |
|
1,102 |
1,035 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
42 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
21 |
16 |
$0.00 |