| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,030 |
2,149 |
$122K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,703 |
2,646 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,474 |
2,449 |
$32K |
| D1110 |
Prophylaxis - adult |
656 |
648 |
$17K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
372 |
330 |
$17K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
606 |
526 |
$17K |
| 80305 |
|
1,378 |
768 |
$14K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
301 |
272 |
$13K |
| D0191 |
|
1,094 |
1,092 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
465 |
$11K |
| D1351 |
Sealant - per tooth |
598 |
168 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
376 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
556 |
516 |
$4K |
| 0012A |
|
107 |
104 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
198 |
191 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
376 |
310 |
$3K |
| 0011A |
|
125 |
122 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
101 |
94 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D1120 |
Prophylaxis - child |
87 |
87 |
$2K |
| 0071A |
|
47 |
46 |
$2K |
| 0013A |
|
54 |
54 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
170 |
155 |
$1K |
| 90686 |
|
233 |
180 |
$1K |
| 99441 |
|
199 |
142 |
$890.98 |
| 0002A |
|
19 |
19 |
$725.04 |
| 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 |
14 |
13 |
$667.03 |
| 99443 |
|
52 |
18 |
$527.51 |
| 0001A |
|
13 |
13 |
$496.08 |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$489.93 |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$339.90 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
39 |
36 |
$304.77 |
| 99442 |
|
30 |
17 |
$273.78 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$216.60 |
| 90674 |
|
12 |
12 |
$213.31 |
| 84443 |
Thyroid stimulating hormone (TSH) |
13 |
12 |
$151.20 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
95 |
70 |
$121.81 |
| 80053 |
Comprehensive metabolic panel |
12 |
12 |
$116.16 |
| 85027 |
|
19 |
17 |
$86.50 |
| 85018 |
|
24 |
15 |
$32.23 |
| 82962 |
|
20 |
13 |
$31.90 |
| 82947 |
|
20 |
13 |
$0.00 |
| D1330 |
|
99 |
99 |
$0.00 |
| D1353 |
|
379 |
141 |
$0.00 |
| D1310 |
|
12 |
12 |
$0.00 |