| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,924 |
3,278 |
$73K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,376 |
5,294 |
$69K |
| D1110 |
Prophylaxis - adult |
437 |
248 |
$11K |
| S5100 |
Day care services, adult; per 15 minutes |
168 |
12 |
$9K |
| D1206 |
Topical application of fluoride varnish |
421 |
228 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
228 |
117 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
2,844 |
2,457 |
$3K |
| 90686 |
|
306 |
286 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
678 |
440 |
$2K |
| 69209 |
|
557 |
516 |
$2K |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
390 |
352 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
322 |
290 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
231 |
213 |
$2K |
| D0274 |
Bitewings - four radiographic images |
123 |
55 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
207 |
96 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
187 |
74 |
$775.13 |
| 90682 |
|
55 |
51 |
$712.80 |
| D0140 |
Limited oral evaluation - problem focused |
87 |
44 |
$512.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
127 |
113 |
$481.54 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
71 |
61 |
$244.57 |
| 90656 |
|
56 |
52 |
$225.00 |
| 99490 |
Ccm add 20min |
17 |
15 |
$206.62 |
| 93000 |
|
31 |
30 |
$188.03 |
| 81003 |
|
321 |
292 |
$171.07 |
| V5008 |
Hearing screening |
76 |
73 |
$117.82 |
| G0008 |
Administration of influenza virus vaccine |
208 |
199 |
$13.12 |
| D1330 |
|
24 |
23 |
$0.00 |
| D4346 |
|
64 |
16 |
$0.00 |
| D9410 |
|
22 |
21 |
$0.00 |
| D0191 |
|
27 |
25 |
$0.00 |