| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
60,128 |
21,585 |
$24.81M |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$10K |
| D1110 |
Prophylaxis - adult |
418 |
213 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
404 |
324 |
$0.00 |
| V2020 |
Frames, purchases |
55 |
48 |
$0.00 |
| 80305 |
|
12 |
12 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
49 |
46 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
607 |
270 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
190 |
99 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
227 |
191 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$0.00 |
| D0190 |
|
773 |
353 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
26 |
$0.00 |
| 92015 |
Determination of refractive state |
111 |
108 |
$0.00 |
| 84439 |
|
14 |
12 |
$0.00 |
| H0022 |
Alcohol and/or drug intervention service (planned facilitation) |
29 |
12 |
$0.00 |
| 81003 |
|
71 |
61 |
$0.00 |
| 81025 |
|
14 |
14 |
$0.00 |
| 0054A |
|
51 |
39 |
$0.00 |
| 0013A |
|
17 |
13 |
$0.00 |
| 90734 |
|
17 |
14 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
101 |
63 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,063 |
888 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
164 |
141 |
$0.00 |
| 99000 |
|
554 |
471 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
130 |
123 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
766 |
637 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
255 |
223 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
415 |
364 |
$0.00 |
| 90480 |
|
15 |
13 |
$0.00 |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
479 |
355 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
698 |
190 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
852 |
352 |
$0.00 |
| D1310 |
|
795 |
363 |
$0.00 |
| 87428 |
|
413 |
156 |
$0.00 |
| 90686 |
|
81 |
69 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
63 |
59 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
73 |
69 |
$0.00 |
| D1330 |
|
802 |
364 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
152 |
130 |
$0.00 |
| 36416 |
|
35 |
27 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
122 |
68 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
33 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
13 |
$0.00 |