| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
650 |
606 |
$180K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,676 |
1,312 |
$170K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,857 |
1,425 |
$147K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,152 |
1,070 |
$131K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
161 |
150 |
$81K |
| D1206 |
Topical application of fluoride varnish |
166 |
162 |
$50K |
| W0037 |
|
559 |
559 |
$39K |
| 0012A |
|
73 |
72 |
$34K |
| 0011A |
|
72 |
71 |
$33K |
| 0001A |
|
37 |
36 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
165 |
153 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
409 |
392 |
$15K |
| 81003 |
|
27 |
26 |
$13K |
| 0071A |
|
27 |
24 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
52 |
34 |
$9K |
| 0072A |
|
15 |
14 |
$7K |
| 0002A |
|
13 |
13 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
28 |
25 |
$5K |
| 90686 |
|
28 |
27 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
109 |
$4K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$2K |
| 98967 |
|
18 |
16 |
$348.02 |
| 99442 |
|
12 |
12 |
$235.55 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$190.36 |
| 99441 |
|
23 |
13 |
$33.60 |
| 36415 |
Collection of venous blood by venipuncture |
155 |
144 |
$0.00 |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
16 |
16 |
$0.00 |