| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,063 |
4,741 |
$415K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,560 |
3,848 |
$184K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
973 |
867 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
269 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
222 |
196 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
134 |
133 |
$6K |
| D1206 |
Topical application of fluoride varnish |
174 |
173 |
$2K |
| D1120 |
Prophylaxis - child |
162 |
162 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
97 |
93 |
$413.34 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$245.44 |
| 36415 |
Collection of venous blood by venipuncture |
221 |
203 |
$105.53 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
67 |
66 |
$100.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
79 |
72 |
$66.42 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
15 |
$31.22 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
89 |
79 |
$10.32 |
| 81003 |
|
18 |
16 |
$3.06 |
| 91301 |
|
28 |
27 |
$0.00 |
| 0011A |
|
14 |
13 |
$0.00 |
| 0013A |
|
12 |
12 |
$0.00 |