| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,225 |
1,033 |
$538K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
220 |
205 |
$123K |
| D1110 |
Prophylaxis - adult |
251 |
240 |
$104K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
174 |
159 |
$85K |
| D1206 |
Topical application of fluoride varnish |
565 |
539 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
82 |
82 |
$24K |
| D1120 |
Prophylaxis - child |
57 |
52 |
$22K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
32 |
31 |
$19K |
| 99173 |
|
105 |
104 |
$10K |
| 0071A |
|
18 |
18 |
$9K |
| 0072A |
|
16 |
16 |
$8K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
193 |
176 |
$8K |
| 0002A |
|
14 |
14 |
$7K |
| 0001A |
|
13 |
13 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
14 |
$654.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
12 |
$0.00 |
| D0190 |
|
21 |
21 |
$0.00 |
| D1330 |
|
255 |
241 |
$0.00 |
| D0603 |
|
26 |
21 |
$0.00 |