| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,076 |
10,723 |
$749K |
| T1015 |
Clinic visit/encounter, all-inclusive |
4,606 |
3,483 |
$434K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
2,211 |
2,064 |
$70K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
331 |
308 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
663 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
729 |
719 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
977 |
962 |
$19K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,011 |
967 |
$19K |
| D1120 |
Prophylaxis - child |
858 |
847 |
$16K |
| 92552 |
|
662 |
661 |
$13K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
837 |
610 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
303 |
279 |
$12K |
| D1110 |
Prophylaxis - adult |
249 |
243 |
$11K |
| 0002A |
|
267 |
267 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
356 |
315 |
$10K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
174 |
164 |
$9K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
612 |
600 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
65 |
$8K |
| 0001A |
|
288 |
288 |
$7K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
410 |
391 |
$6K |
| D0274 |
Bitewings - four radiographic images |
430 |
420 |
$6K |
| D1999 |
|
337 |
260 |
$4K |
| 90688 |
|
302 |
299 |
$4K |
| 90686 |
|
266 |
265 |
$3K |
| 90836 |
|
59 |
40 |
$3K |
| 85018 |
|
1,275 |
1,267 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
24 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
24 |
24 |
$2K |
| 96127 |
|
937 |
635 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
25 |
25 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
363 |
328 |
$2K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$1K |
| 0071A |
|
42 |
42 |
$984.48 |
| 0072A |
|
37 |
37 |
$867.28 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
17 |
12 |
$697.98 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
52 |
$549.18 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
40 |
40 |
$543.32 |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$514.50 |
| 90674 |
|
25 |
25 |
$400.50 |
| 83655 |
|
27 |
26 |
$382.01 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$346.54 |
| 99173 |
|
16 |
16 |
$26.61 |
| 99188 |
|
121 |
119 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
14 |
14 |
$0.00 |