| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,400 |
2,807 |
$393K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,347 |
1,961 |
$212K |
| D1206 |
Topical application of fluoride varnish |
477 |
459 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
70 |
$9K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
969 |
706 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
121 |
112 |
$5K |
| D1120 |
Prophylaxis - child |
126 |
119 |
$5K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
69 |
64 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
597 |
568 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$2K |
| D0274 |
Bitewings - four radiographic images |
20 |
19 |
$1K |
| 90686 |
|
156 |
150 |
$206.12 |
| 99173 |
|
47 |
43 |
$174.16 |
| 99000 |
|
1,987 |
1,762 |
$173.14 |
| 36415 |
Collection of venous blood by venipuncture |
1,943 |
1,697 |
$6.34 |
| D1330 |
|
203 |
193 |
$0.00 |
| D0602 |
|
62 |
62 |
$0.00 |
| D1310 |
|
51 |
51 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
29 |
$0.00 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
67 |
59 |
$0.00 |
| 4000F |
|
15 |
13 |
$0.00 |
| D0190 |
|
249 |
245 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
92 |
81 |
$0.00 |
| 81002 |
|
28 |
26 |
$0.00 |
| 0502F |
|
15 |
12 |
$0.00 |