| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
4,349 |
3,668 |
$1.24M |
| T1015 |
Clinic visit/encounter, all-inclusive |
3,454 |
2,604 |
$878K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,655 |
1,484 |
$59K |
| 90837 |
Psychotherapy, 53 minutes with patient |
529 |
325 |
$42K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
30 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
36 |
32 |
$814.14 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$786.80 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
15 |
13 |
$498.00 |
| D0120 |
Periodic oral evaluation - established patient |
778 |
722 |
$418.76 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
72 |
64 |
$389.20 |
| D0274 |
Bitewings - four radiographic images |
141 |
134 |
$381.45 |
| D1110 |
Prophylaxis - adult |
161 |
157 |
$372.17 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
67 |
63 |
$333.36 |
| D0330 |
Panoramic radiographic image |
72 |
71 |
$306.80 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
151 |
$236.79 |
| D1206 |
Topical application of fluoride varnish |
1,217 |
1,152 |
$140.70 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
26 |
$25.30 |
| 90686 |
|
28 |
27 |
$18.55 |
| D0602 |
|
515 |
489 |
$0.00 |
| D0603 |
|
940 |
886 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
44 |
42 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| 92587 |
|
15 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
410 |
373 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
16 |
$0.00 |
| 99173 |
|
15 |
14 |
$0.00 |