| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,748 |
1,459 |
$425K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,372 |
1,221 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
265 |
197 |
$24K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
103 |
98 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
260 |
257 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
51 |
51 |
$3K |
| 3008F |
|
197 |
197 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
433 |
412 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
46 |
44 |
$959.76 |
| 92551 |
|
107 |
106 |
$658.73 |
| 99429 |
|
57 |
57 |
$570.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$412.85 |
| D1120 |
Prophylaxis - child |
129 |
129 |
$391.25 |
| 81002 |
|
261 |
254 |
$384.76 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
41 |
40 |
$303.60 |
| 90461 |
|
13 |
13 |
$199.50 |
| 99173 |
|
125 |
125 |
$171.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$105.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$60.00 |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
97 |
$51.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$50.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
929 |
395 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
868 |
491 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
33 |
$0.00 |