| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,898 |
8,381 |
$1.21M |
| 0012A |
|
15 |
13 |
$480.00 |
| 0011A |
|
15 |
15 |
$40.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
673 |
625 |
$35.00 |
| 90686 |
|
221 |
217 |
$10.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
511 |
453 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
822 |
772 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
796 |
741 |
$0.00 |
| 96127 |
|
477 |
440 |
$0.00 |
| 3008F |
|
1,631 |
1,527 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
490 |
488 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
112 |
111 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
103 |
98 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
35 |
35 |
$0.00 |
| 91301 |
|
36 |
35 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$0.00 |
| 3079F |
|
13 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
149 |
136 |
$0.00 |
| 99173 |
|
383 |
351 |
$0.00 |
| 1160F |
|
1,513 |
1,419 |
$0.00 |
| D1110 |
Prophylaxis - adult |
353 |
352 |
$0.00 |
| 92552 |
|
303 |
278 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
348 |
348 |
$0.00 |
| 1032F |
|
150 |
133 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
30 |
26 |
$0.00 |
| 1159F |
|
93 |
93 |
$0.00 |
| D1120 |
Prophylaxis - child |
152 |
151 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |
| 90461 |
|
16 |
12 |
$0.00 |