| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,724 |
5,922 |
$125K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
37 |
26 |
$1K |
| D1110 |
Prophylaxis - adult |
18 |
18 |
$473.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$317.33 |
| 99201 |
|
120 |
95 |
$309.00 |
| D1999 |
|
18 |
18 |
$246.67 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
58 |
41 |
$232.66 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
866 |
777 |
$222.94 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
563 |
510 |
$202.69 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
567 |
514 |
$196.52 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
190 |
138 |
$156.00 |
| 86780 |
|
130 |
115 |
$80.24 |
| 86593 |
|
1,039 |
926 |
$75.55 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
21 |
16 |
$23.38 |
| 87590 |
|
227 |
188 |
$19.12 |
| 87490 |
|
231 |
191 |
$19.12 |
| 90658 |
|
28 |
25 |
$11.37 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
79 |
51 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$0.00 |