| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90837 |
Psychotherapy, 53 minutes with patient |
20 |
13 |
$760.47 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
51 |
38 |
$441.41 |
| D0120 |
Periodic oral evaluation - established patient |
19 |
19 |
$317.35 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$132.30 |
| 92551 |
|
22 |
13 |
$66.78 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
96 |
79 |
$59.84 |
| D1330 |
|
17 |
17 |
$0.00 |
| D0603 |
|
16 |
16 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
64 |
63 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20 |
13 |
$0.00 |
| 90658 |
|
66 |
64 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28 |
23 |
$0.00 |
| 99173 |
|
22 |
13 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
22 |
13 |
$0.00 |