| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,492 |
5,155 |
$1.15M |
| 00003 |
Internal/system code - not a standard HCPCS code |
3,434 |
2,512 |
$836K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,142 |
3,881 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
58 |
49 |
$395.15 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
457 |
388 |
$142.12 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
12 |
$137.11 |
| 90832 |
Psychotherapy, 30 minutes with patient |
22 |
15 |
$135.66 |
| 90656 |
|
34 |
29 |
$48.46 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
89 |
$0.00 |
| 92551 |
|
111 |
101 |
$0.00 |
| 2010F |
|
1,197 |
1,000 |
$0.00 |
| 1036F |
|
1,222 |
973 |
$0.00 |
| 2001F |
|
1,175 |
981 |
$0.00 |
| 3008F |
|
1,175 |
982 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
53 |
$0.00 |
| 1000F |
|
149 |
135 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
14 |
14 |
$0.00 |
| 85018 |
|
401 |
347 |
$0.00 |
| 2000F |
|
900 |
769 |
$0.00 |
| 3074F |
|
406 |
368 |
$0.00 |
| 96156 |
|
210 |
199 |
$0.00 |
| 97802 |
|
76 |
76 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
62 |
61 |
$0.00 |
| 36416 |
|
73 |
73 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
40 |
$0.00 |
| 3079F |
|
44 |
41 |
$0.00 |
| D0603 |
|
83 |
82 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$0.00 |
| D1330 |
|
70 |
70 |
$0.00 |
| 3351F |
|
42 |
40 |
$0.00 |
| 1159F |
|
971 |
785 |
$0.00 |
| 3078F |
|
291 |
270 |
$0.00 |
| 1160F |
|
957 |
773 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
364 |
316 |
$0.00 |
| 99173 |
|
94 |
87 |
$0.00 |
| 4004F |
|
14 |
12 |
$0.00 |
| 98960 |
|
232 |
218 |
$0.00 |
| D1120 |
Prophylaxis - child |
28 |
28 |
$0.00 |
| 90461 |
|
96 |
83 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
28 |
24 |
$0.00 |
| 90671 |
|
15 |
13 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$0.00 |