| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,721 |
6,865 |
$192K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,102 |
3,692 |
$152K |
| D1206 |
Topical application of fluoride varnish |
9,473 |
9,196 |
$124K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,883 |
2,657 |
$99K |
| D1110 |
Prophylaxis - adult |
3,711 |
3,611 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
5,749 |
5,579 |
$83K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,164 |
3,079 |
$61K |
| D1120 |
Prophylaxis - child |
2,186 |
2,155 |
$49K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
5,833 |
5,419 |
$46K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,528 |
1,410 |
$46K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,528 |
1,410 |
$45K |
| 80053 |
Comprehensive metabolic panel |
5,220 |
4,721 |
$42K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
729 |
674 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,837 |
1,760 |
$37K |
| 80061 |
Lipid panel |
3,197 |
2,946 |
$35K |
| 84443 |
Thyroid stimulating hormone (TSH) |
2,661 |
2,380 |
$33K |
| 92015 |
Determination of refractive state |
4,065 |
3,732 |
$32K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
543 |
520 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,708 |
1,646 |
$29K |
| D0330 |
Panoramic radiographic image |
577 |
564 |
$20K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
2,940 |
2,607 |
$17K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
664 |
601 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
601 |
590 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,049 |
1,038 |
$15K |
| D1351 |
Sealant - per tooth |
938 |
236 |
$14K |
| 85027 |
|
2,629 |
2,375 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,459 |
1,397 |
$12K |
| 99000 |
|
3,863 |
3,500 |
$10K |
| 90686 |
|
1,050 |
987 |
$8K |
| 81025 |
|
1,163 |
1,035 |
$8K |
| 81001 |
|
2,631 |
2,390 |
$6K |
| 80050 |
General health panel |
305 |
111 |
$5K |
| 80306 |
|
370 |
339 |
$5K |
| 84439 |
|
727 |
644 |
$5K |
| 99215 |
Prolong outpt/office vis |
88 |
81 |
$4K |
| 87210 |
|
860 |
784 |
$4K |
| 81003 |
|
1,787 |
1,133 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
416 |
354 |
$4K |
| 82043 |
|
748 |
706 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
53 |
51 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
89 |
84 |
$3K |
| G0127 |
Trimming of dystrophic nails, any number |
468 |
448 |
$2K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
358 |
316 |
$2K |
| 91322 |
|
23 |
19 |
$2K |
| 83655 |
|
232 |
197 |
$2K |
| 80069 |
|
306 |
278 |
$2K |
| 87806 |
|
89 |
76 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
149 |
87 |
$2K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
60 |
58 |
$2K |
| 90670 |
|
545 |
499 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |
| 90723 |
|
258 |
241 |
$996.86 |
| Q3014 |
Telehealth originating site facility fee |
46 |
38 |
$952.98 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
66 |
61 |
$861.96 |
| 90647 |
|
275 |
255 |
$797.71 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
20 |
18 |
$765.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
27 |
$736.02 |
| 84481 |
|
69 |
63 |
$709.52 |
| 90480 |
|
24 |
20 |
$655.26 |
| 90672 |
|
28 |
28 |
$575.00 |
| 90677 |
|
47 |
42 |
$510.00 |
| 82570 |
|
128 |
124 |
$507.72 |
| 80074 |
|
14 |
13 |
$483.44 |
| 90656 |
|
35 |
30 |
$455.93 |
| 36415 |
Collection of venous blood by venipuncture |
3,364 |
3,021 |
$281.98 |
| 83550 |
|
45 |
40 |
$278.17 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
17 |
14 |
$277.07 |
| 83540 |
|
45 |
40 |
$205.66 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
154 |
145 |
$178.91 |
| 90681 |
|
52 |
50 |
$155.57 |
| 36416 |
|
16 |
14 |
$6.06 |
| 3008F |
|
108 |
104 |
$0.00 |
| D1330 |
|
24 |
24 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
195 |
185 |
$0.00 |
| 97803 |
|
12 |
12 |
$0.00 |
| D0190 |
|
128 |
127 |
$0.00 |
| 98960 |
|
17 |
13 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
64 |
28 |
$0.00 |