| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,695 |
6,432 |
$196K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,891 |
3,040 |
$83K |
| 99401 |
|
1,702 |
1,377 |
$15K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
769 |
517 |
$7K |
| 36415 |
Collection of venous blood by venipuncture |
7,698 |
5,719 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
72 |
$5K |
| T1015 |
Clinic visit/encounter, all-inclusive |
180 |
107 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
49 |
$2K |
| 90677 |
|
14 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
29 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
516 |
301 |
$1K |
| 99442 |
|
225 |
100 |
$1K |
| 90674 |
|
46 |
42 |
$1K |
| 99443 |
|
86 |
56 |
$925.70 |
| 1159F |
|
907 |
704 |
$875.00 |
| 1160F |
|
921 |
712 |
$850.00 |
| 90686 |
|
95 |
58 |
$803.60 |
| 0012A |
|
21 |
21 |
$780.00 |
| 99215 |
Prolong outpt/office vis |
18 |
14 |
$562.36 |
| 90656 |
|
39 |
35 |
$516.14 |
| 3074F |
|
103 |
101 |
$325.00 |
| 96127 |
|
115 |
100 |
$306.38 |
| 0011A |
|
18 |
18 |
$270.55 |
| 3079F |
|
55 |
52 |
$225.00 |
| 3078F |
|
78 |
74 |
$200.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
94 |
$136.92 |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
50 |
$102.95 |
| 99490 |
Ccm add 20min |
22 |
15 |
$20.78 |
| 96160 |
|
20 |
15 |
$18.91 |
| D0431 |
|
12 |
12 |
$0.00 |
| J0741 |
Injection, cabotegravir and rilpivirine, 2mg/3mg |
12 |
12 |
$0.00 |