| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
310 |
251 |
$56.72 |
| 90461 |
|
106 |
106 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
259 |
259 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
59 |
44 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
138 |
135 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
76 |
48 |
$0.00 |
| 90670 |
|
124 |
124 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
41 |
$0.00 |
| 99173 |
|
13 |
13 |
$0.00 |
| D0350 |
|
57 |
43 |
$0.00 |
| 80061 |
Lipid panel |
14 |
14 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
32 |
26 |
$0.00 |
| 99442 |
|
12 |
12 |
$0.00 |
| 4450F |
|
31 |
31 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
730 |
641 |
$0.00 |
| 85027 |
|
124 |
124 |
$0.00 |
| 98967 |
|
12 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
357 |
354 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
106 |
85 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
40 |
$0.00 |
| D1330 |
|
59 |
44 |
$0.00 |
| 90698 |
|
27 |
27 |
$0.00 |
| 90680 |
|
13 |
13 |
$0.00 |
| 70300 |
|
55 |
55 |
$0.00 |
| 99443 |
|
15 |
15 |
$0.00 |
| 99441 |
|
13 |
13 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$0.00 |