| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
22 |
22 |
$120.45 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
66 |
64 |
$116.35 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
39 |
39 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$0.00 |
| 3079F |
|
14 |
14 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$0.00 |
| 90686 |
|
19 |
19 |
$0.00 |
| 3074F |
|
32 |
32 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
13 |
13 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 90833 |
Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) |
13 |
13 |
$0.00 |
| 3078F |
|
17 |
17 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
243 |
239 |
$0.00 |
| 4004F |
|
14 |
14 |
$0.00 |
| 80305 |
|
13 |
13 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
24 |
24 |
$0.00 |
| 99408 |
|
13 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$0.00 |