| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,885 |
6,589 |
$3.64M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,590 |
3,145 |
$1.66M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,621 |
2,265 |
$1.33M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,039 |
1,391 |
$707K |
| 90832 |
Psychotherapy, 30 minutes with patient |
547 |
368 |
$336K |
| D1206 |
Topical application of fluoride varnish |
622 |
620 |
$129K |
| S0215 |
Non-emergency transportation; mileage, per mile |
1,086 |
799 |
$127K |
| D0140 |
Limited oral evaluation - problem focused |
477 |
445 |
$109K |
| 81003 |
|
2,408 |
1,976 |
$101K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
182 |
180 |
$90K |
| W0037 |
|
3,044 |
3,044 |
$55K |
| D1120 |
Prophylaxis - child |
229 |
229 |
$46K |
| 0054A |
|
66 |
66 |
$40K |
| 0011A |
|
75 |
74 |
$34K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
45 |
45 |
$27K |
| 0064A |
|
54 |
54 |
$26K |
| 0001A |
|
56 |
56 |
$22K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
43 |
43 |
$22K |
| 0071A |
|
52 |
52 |
$22K |
| 0002A |
|
53 |
53 |
$21K |
| 0072A |
|
32 |
32 |
$19K |
| 0012A |
|
37 |
37 |
$19K |
| 99506 |
|
48 |
43 |
$18K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,975 |
4,238 |
$16K |
| 0052A |
|
28 |
28 |
$14K |
| 0074A |
|
20 |
20 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
169 |
$13K |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
1,631 |
1,127 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
27 |
$11K |
| 96127 |
|
45 |
42 |
$10K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,926 |
1,726 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
59 |
55 |
$8K |
| 0073A |
|
12 |
12 |
$7K |
| 0124A |
|
12 |
12 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$7K |
| 0134A |
|
12 |
12 |
$6K |
| A0425 |
Ground mileage, per statute mile |
50 |
46 |
$5K |
| 0051A |
|
13 |
13 |
$5K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$3K |
| 87430 |
|
4,132 |
3,651 |
$2K |
| 85018 |
|
58 |
49 |
$2K |
| 92015 |
Determination of refractive state |
113 |
105 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
330 |
316 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
125 |
125 |
$882.00 |
| 82947 |
|
28 |
27 |
$519.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
716 |
653 |
$519.00 |
| 87070 |
|
661 |
600 |
$519.00 |
| 84703 |
|
274 |
263 |
$519.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,546 |
1,409 |
$0.00 |
| 81025 |
|
230 |
222 |
$0.00 |
| 80061 |
Lipid panel |
357 |
344 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
4,860 |
2,196 |
$0.00 |
| 80076 |
|
136 |
125 |
$0.00 |
| 0 |
Res change sc >=0 |
318 |
292 |
$0.00 |
| 86756 |
|
96 |
90 |
$0.00 |
| 85014 |
|
19 |
19 |
$0.00 |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,777 |
1,583 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
1,080 |
982 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
234 |
234 |
$0.00 |
| 85027 |
|
256 |
236 |
$0.00 |
| 87807 |
|
96 |
90 |
$0.00 |
| 86140 |
|
114 |
103 |
$0.00 |
| 81015 |
|
82 |
78 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
128 |
117 |
$0.00 |
| D1351 |
Sealant - per tooth |
65 |
22 |
$0.00 |