| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,398 |
11,039 |
$2.17M |
| D0999 |
Unspecified diagnostic procedure, by report |
948 |
472 |
$88K |
| H2020 |
Therapeutic behavioral services, per diem |
415 |
137 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
70 |
$139.98 |
| 99051 |
|
106 |
38 |
$40.14 |
| 99173 |
|
571 |
422 |
$1.91 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,371 |
5,992 |
$0.02 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,603 |
2,057 |
$0.00 |
| D0330 |
Panoramic radiographic image |
150 |
109 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
268 |
221 |
$0.00 |
| 80061 |
Lipid panel |
186 |
141 |
$0.00 |
| 3725F |
|
27 |
15 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
216 |
72 |
$0.00 |
| 81025 |
|
159 |
102 |
$0.00 |
| 99442 |
|
327 |
105 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
38 |
25 |
$0.00 |
| D1120 |
Prophylaxis - child |
35 |
26 |
$0.00 |
| 3351F |
|
554 |
379 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
196 |
148 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
931 |
644 |
$0.00 |
| D9995 |
|
59 |
29 |
$0.00 |
| 1220F |
|
469 |
331 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
186 |
143 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
96 |
58 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
191 |
143 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
35 |
31 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
191 |
144 |
$0.00 |
| 93000 |
|
68 |
41 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
200 |
176 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
28 |
$0.00 |
| D1330 |
|
24 |
13 |
$0.00 |
| 99381 |
|
14 |
12 |
$0.00 |
| 99383 |
|
74 |
42 |
$0.00 |