| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,150 |
9,253 |
$5.34M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,397 |
2,177 |
$1.19M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,652 |
1,470 |
$903K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,182 |
2,954 |
$420K |
| D1206 |
Topical application of fluoride varnish |
1,166 |
1,160 |
$330K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
571 |
564 |
$298K |
| 99215 |
Prolong outpt/office vis |
507 |
459 |
$296K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
664 |
565 |
$249K |
| S0215 |
Non-emergency transportation; mileage, per mile |
2,146 |
1,113 |
$226K |
| D0140 |
Limited oral evaluation - problem focused |
560 |
531 |
$195K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
551 |
504 |
$162K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
291 |
269 |
$158K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,313 |
1,082 |
$137K |
| W0037 |
|
4,625 |
4,625 |
$113K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
185 |
178 |
$111K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
137 |
126 |
$77K |
| 0002A |
|
151 |
151 |
$72K |
| 0001A |
|
144 |
144 |
$67K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
2,504 |
2,292 |
$55K |
| 0012A |
|
92 |
92 |
$46K |
| 0031A |
|
79 |
79 |
$38K |
| D1120 |
Prophylaxis - child |
149 |
149 |
$32K |
| 0011A |
|
80 |
78 |
$30K |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
3,249 |
1,354 |
$25K |
| 42700 |
|
60 |
57 |
$24K |
| 99600 |
Unlisted home visit service or procedure |
60 |
50 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
118 |
$21K |
| 0072A |
|
33 |
33 |
$20K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
940 |
904 |
$18K |
| A0425 |
Ground mileage, per statute mile |
145 |
46 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
99 |
$13K |
| 0052A |
|
18 |
18 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$11K |
| 92015 |
Determination of refractive state |
843 |
806 |
$10K |
| 0071A |
|
37 |
36 |
$8K |
| D0274 |
Bitewings - four radiographic images |
41 |
41 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
38 |
$8K |
| 80053 |
Comprehensive metabolic panel |
1,813 |
1,679 |
$7K |
| 81003 |
|
1,452 |
1,346 |
$7K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$7K |
| 82270 |
|
13 |
13 |
$6K |
| 0051A |
|
12 |
12 |
$6K |
| 0064A |
|
30 |
28 |
$6K |
| D1351 |
Sealant - per tooth |
99 |
25 |
$4K |
| 85014 |
|
91 |
90 |
$4K |
| 81025 |
|
315 |
297 |
$4K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
98 |
89 |
$3K |
| 0134A |
|
15 |
15 |
$3K |
| 90686 |
|
1,526 |
1,407 |
$2K |
| 80061 |
Lipid panel |
268 |
257 |
$1K |
| 0054A |
|
25 |
20 |
$1K |
| 87449 |
|
1,669 |
1,560 |
$1K |
| 71046 |
Radiologic examination, chest; 2 views |
54 |
44 |
$719.00 |
| 90656 |
|
310 |
310 |
$719.00 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
1,364 |
1,300 |
$654.00 |
| 90723 |
|
76 |
66 |
$654.00 |
| 90651 |
|
167 |
157 |
$640.00 |
| 87070 |
|
211 |
198 |
$519.00 |
| G0008 |
Administration of influenza virus vaccine |
30 |
25 |
$29.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,722 |
1,540 |
$15.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
463 |
443 |
$10.35 |
| 99188 |
|
228 |
204 |
$0.00 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
403 |
384 |
$0.00 |
| 90710 |
|
53 |
43 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
116 |
56 |
$0.00 |
| 90670 |
|
123 |
106 |
$0.00 |
| 91300 |
|
138 |
135 |
$0.00 |
| 90633 |
|
48 |
40 |
$0.00 |
| 90734 |
|
117 |
100 |
$0.00 |
| 90715 |
|
119 |
106 |
$0.00 |
| 90756 |
|
39 |
38 |
$0.00 |
| 91312 |
|
14 |
14 |
$0.00 |
| 91322 |
|
98 |
97 |
$0.00 |
| 1 |
Lens, 1.54-1.65 p/1.60-1.79g |
16 |
12 |
$0.00 |
| 91313 |
|
15 |
15 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
12 |
12 |
$0.00 |
| 0124A |
|
14 |
14 |
$0.00 |
| 90671 |
|
28 |
26 |
$0.00 |
| 90480 |
|
148 |
148 |
$0.00 |
| 91305 |
|
146 |
130 |
$0.00 |
| 85018 |
|
91 |
90 |
$0.00 |
| 91306 |
|
55 |
53 |
$0.00 |
| 87807 |
|
31 |
29 |
$0.00 |
| 91307 |
|
346 |
304 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
316 |
261 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
29 |
29 |
$0.00 |
| 90647 |
|
64 |
53 |
$0.00 |
| D0603 |
|
15 |
15 |
$0.00 |
| 90739 |
|
30 |
27 |
$0.00 |
| 90620 |
|
77 |
73 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$0.00 |
| 91303 |
|
23 |
23 |
$0.00 |