| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,136 |
4,255 |
$625K |
| H2020 |
Therapeutic behavioral services, per diem |
3,209 |
1,670 |
$362K |
| D0999 |
Unspecified diagnostic procedure, by report |
319 |
220 |
$42K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,102 |
677 |
$78.36 |
| 90834 |
Psychotherapy, 45 minutes with patient |
832 |
532 |
$48.83 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
37 |
$0.00 |
| 99173 |
|
236 |
215 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,461 |
712 |
$0.00 |
| D1110 |
Prophylaxis - adult |
76 |
62 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
44 |
42 |
$0.00 |
| 81003 |
|
293 |
245 |
$0.00 |
| 92552 |
|
178 |
159 |
$0.00 |
| D1120 |
Prophylaxis - child |
26 |
26 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
45 |
44 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
20 |
20 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
17 |
17 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
16 |
12 |
$0.00 |
| 85018 |
|
171 |
152 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,035 |
821 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,407 |
1,776 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$0.00 |
| 82962 |
|
36 |
30 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
21 |
21 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
13 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
17 |
$0.00 |
| 96127 |
|
37 |
27 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
35 |
32 |
$0.00 |