| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,311 |
867 |
$29K |
| D1110 |
Prophylaxis - adult |
641 |
628 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,122 |
1,103 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
849 |
833 |
$21K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
783 |
498 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
512 |
504 |
$15K |
| D0330 |
Panoramic radiographic image |
376 |
369 |
$14K |
| D1120 |
Prophylaxis - child |
409 |
405 |
$14K |
| D0274 |
Bitewings - four radiographic images |
490 |
480 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
114 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
96 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
265 |
197 |
$7K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
103 |
72 |
$4K |
| D0272 |
Bitewings - two radiographic images |
122 |
122 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
83 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
190 |
141 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
161 |
123 |
$882.04 |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
85 |
$832.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$498.15 |
| 36415 |
Collection of venous blood by venipuncture |
78 |
66 |
$105.34 |
| 96127 |
|
15 |
14 |
$43.57 |
| 99000 |
|
326 |
254 |
$0.00 |