| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,818 |
1,257 |
$126K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,628 |
1,081 |
$100K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
327 |
251 |
$29K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
530 |
212 |
$20K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
163 |
123 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
25 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
29 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
65 |
42 |
$1K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
60 |
56 |
$698.36 |
| 97803 |
|
485 |
332 |
$673.98 |
| 85018 |
|
31 |
30 |
$0.00 |
| 3008F |
|
19 |
16 |
$0.00 |
| 92551 |
|
72 |
58 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| 1160F |
|
67 |
50 |
$0.00 |
| 92081 |
|
23 |
18 |
$0.00 |
| 1159F |
|
66 |
50 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
22 |
20 |
$0.00 |