| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,349 |
1,252 |
$60K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
458 |
418 |
$15K |
| D1206 |
Topical application of fluoride varnish |
757 |
742 |
$10K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
831 |
762 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
383 |
$7K |
| 92587 |
|
115 |
109 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
78 |
68 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
62 |
57 |
$3K |
| 92015 |
Determination of refractive state |
336 |
327 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
166 |
159 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
46 |
44 |
$2K |
| D1110 |
Prophylaxis - adult |
50 |
49 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
26 |
26 |
$1K |
| 92567 |
|
106 |
102 |
$1K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
17 |
16 |
$1K |
| 92551 |
|
108 |
102 |
$1K |
| 99173 |
|
69 |
64 |
$950.00 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
29 |
28 |
$912.34 |
| 87634 |
|
14 |
13 |
$901.29 |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
114 |
$893.26 |
| 99215 |
Prolong outpt/office vis |
18 |
15 |
$888.24 |
| D1120 |
Prophylaxis - child |
39 |
39 |
$880.55 |
| D0191 |
|
443 |
439 |
$803.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$697.68 |
| 0011A |
|
27 |
27 |
$440.44 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
51 |
49 |
$350.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$250.70 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$249.08 |
| 90656 |
|
14 |
12 |
$224.40 |
| 80053 |
Comprehensive metabolic panel |
25 |
25 |
$199.64 |
| 80305 |
|
47 |
12 |
$189.00 |
| 99000 |
|
134 |
120 |
$184.24 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$179.52 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$157.10 |
| 90686 |
|
17 |
17 |
$137.09 |
| 99441 |
|
14 |
12 |
$98.01 |
| 81002 |
|
13 |
12 |
$8.70 |
| 97802 |
|
24 |
24 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
180 |
166 |
$0.00 |
| 91301 |
|
64 |
64 |
$0.00 |
| D1330 |
|
27 |
27 |
$0.00 |
| 91300 |
|
12 |
12 |
$0.00 |
| 99177 |
|
48 |
47 |
$0.00 |
| D0190 |
|
17 |
17 |
$0.00 |