| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,103 |
4,346 |
$1.10M |
| D0999 |
Unspecified diagnostic procedure, by report |
930 |
841 |
$223K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,171 |
2,012 |
$119K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
467 |
452 |
$33K |
| D1110 |
Prophylaxis - adult |
255 |
251 |
$20K |
| 87428 |
|
616 |
588 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
128 |
125 |
$9K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
545 |
523 |
$7K |
| 90837 |
Psychotherapy, 53 minutes with patient |
57 |
37 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
39 |
36 |
$2K |
| 99000 |
|
389 |
367 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
26 |
24 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
162 |
159 |
$153.99 |
| D1208 |
Topical application of fluoride, excluding varnish |
162 |
142 |
$132.30 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
58 |
57 |
$80.47 |
| 90686 |
|
83 |
80 |
$74.62 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
15 |
15 |
$55.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
329 |
102 |
$55.00 |
| D0274 |
Bitewings - four radiographic images |
62 |
60 |
$36.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
218 |
200 |
$29.43 |
| D0220 |
Intraoral - periapical first radiographic image |
126 |
117 |
$14.00 |
| D0601 |
|
101 |
99 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
182 |
176 |
$0.00 |
| 90651 |
|
19 |
17 |
$0.00 |
| D0602 |
|
30 |
30 |
$0.00 |
| 3008F |
|
34 |
30 |
$0.00 |
| 90715 |
|
14 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
12 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
13 |
12 |
$0.00 |
| 90734 |
|
13 |
13 |
$0.00 |
| 99173 |
|
27 |
25 |
$0.00 |