| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,495 |
1,262 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
577 |
511 |
$75K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
39 |
35 |
$2K |
| D1120 |
Prophylaxis - child |
150 |
150 |
$246.25 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
175 |
174 |
$195.00 |
| D1206 |
Topical application of fluoride varnish |
118 |
117 |
$175.00 |
| D0330 |
Panoramic radiographic image |
94 |
94 |
$149.25 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
579 |
517 |
$0.00 |
| 90651 |
|
128 |
127 |
$0.00 |
| 99383 |
|
211 |
211 |
$0.00 |
| D0601 |
|
14 |
13 |
$0.00 |
| 90716 |
|
85 |
85 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
570 |
555 |
$0.00 |
| 99384 |
|
68 |
68 |
$0.00 |
| 90686 |
|
207 |
205 |
$0.00 |
| 90744 |
|
31 |
31 |
$0.00 |
| 90647 |
|
12 |
12 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 99382 |
|
110 |
110 |
$0.00 |
| 90633 |
|
185 |
185 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$0.00 |
| 99173 |
|
550 |
549 |
$0.00 |
| 92552 |
|
460 |
458 |
$0.00 |
| 90713 |
|
91 |
91 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
338 |
337 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
52 |
52 |
$0.00 |
| 90670 |
|
45 |
45 |
$0.00 |
| 90714 |
|
12 |
12 |
$0.00 |
| 90710 |
|
16 |
16 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
39 |
39 |
$0.00 |
| 90707 |
|
71 |
71 |
$0.00 |