| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,246 |
1,005 |
$336K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
255 |
238 |
$33K |
| D0274 |
Bitewings - four radiographic images |
123 |
120 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
71 |
68 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
39 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
18 |
18 |
$1K |
| 92551 |
|
67 |
67 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
33 |
33 |
$877.72 |
| G0008 |
Administration of influenza virus vaccine |
69 |
65 |
$791.60 |
| 99173 |
|
31 |
31 |
$130.17 |
| D1110 |
Prophylaxis - adult |
62 |
62 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
52 |
49 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
94 |
94 |
$0.00 |
| D9996 |
|
24 |
24 |
$0.00 |
| D0603 |
|
139 |
121 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
195 |
195 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
26 |
14 |
$0.00 |