| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,606 |
3,785 |
$298K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,661 |
3,061 |
$110K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
735 |
483 |
$22K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$1K |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
57 |
57 |
$1K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$609.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
104 |
64 |
$571.24 |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$567.00 |
| 36415 |
Collection of venous blood by venipuncture |
231 |
141 |
$284.33 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
44 |
12 |
$224.62 |