| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,562 |
1,311 |
$82K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
252 |
226 |
$21K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
475 |
303 |
$13K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
216 |
203 |
$9K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
145 |
133 |
$8K |
| 99382 |
|
24 |
24 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
101 |
93 |
$1K |
| D1351 |
Sealant - per tooth |
78 |
18 |
$0.00 |
| 96127 |
|
28 |
25 |
$0.00 |
| D1330 |
|
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
38 |
36 |
$0.00 |
| 99173 |
|
800 |
585 |
$0.00 |