| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,778 |
1,384 |
$450K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,404 |
2,156 |
$238K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
913 |
836 |
$86K |
| H0002 |
Behavioral health screening to determine eligibility for admission to treatment program |
496 |
352 |
$59K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
198 |
197 |
$43K |
| H0031 |
Mental health assessment, by non-physician |
271 |
134 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
210 |
198 |
$18K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
111 |
109 |
$15K |
| 90832 |
Psychotherapy, 30 minutes with patient |
116 |
88 |
$13K |
| 90791 |
Psychiatric diagnostic evaluation |
53 |
51 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
42 |
41 |
$5K |
| 90834 |
Psychotherapy, 45 minutes with patient |
31 |
24 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
26 |
26 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
56 |
55 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
631 |
610 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
108 |
105 |
$1K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,654 |
1,469 |
$539.90 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
269 |
$297.00 |
| 99000 |
|
283 |
276 |
$248.36 |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$138.00 |
| D1110 |
Prophylaxis - adult |
88 |
88 |
$105.00 |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
91 |
$31.00 |
| D1206 |
Topical application of fluoride varnish |
451 |
448 |
$6.00 |
| 90686 |
|
121 |
117 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
256 |
251 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
37 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| D0190 |
|
251 |
251 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
52 |
25 |
$0.00 |
| D1120 |
Prophylaxis - child |
28 |
28 |
$0.00 |
| 81003 |
|
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |