| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
157,354 |
126,509 |
$28.63M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
54,393 |
47,738 |
$1.87M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
35,663 |
28,106 |
$1.07M |
| D0999 |
Unspecified diagnostic procedure, by report |
4,363 |
4,068 |
$874K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
11,553 |
11,485 |
$402K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
9,464 |
9,272 |
$292K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
6,606 |
6,564 |
$232K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,528 |
4,325 |
$166K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,962 |
3,944 |
$116K |
| 99381 |
|
1,349 |
1,293 |
$44K |
| 90837 |
Psychotherapy, 53 minutes with patient |
587 |
486 |
$28K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
889 |
858 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,041 |
1,011 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
512 |
497 |
$16K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
199 |
198 |
$15K |
| 90834 |
Psychotherapy, 45 minutes with patient |
156 |
151 |
$8K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
89 |
76 |
$5K |
| 0072A |
|
197 |
197 |
$5K |
| 99205 |
Prolong outpt/office vis |
136 |
125 |
$4K |
| 90791 |
Psychiatric diagnostic evaluation |
77 |
76 |
$3K |
| 0071A |
|
80 |
80 |
$2K |
| 99215 |
Prolong outpt/office vis |
63 |
58 |
$2K |
| 0002A |
|
43 |
43 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
29 |
29 |
$1K |
| 0001A |
|
13 |
13 |
$480.00 |
| D1120 |
Prophylaxis - child |
1,073 |
1,043 |
$330.75 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
70 |
67 |
$310.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
118 |
116 |
$248.00 |
| 96156 |
|
124 |
114 |
$245.93 |
| D0145 |
Oral evaluation for a patient under three years of age |
2,298 |
2,214 |
$170.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
749 |
730 |
$105.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,425 |
1,374 |
$102.90 |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
622 |
$75.36 |
| D0272 |
Bitewings - two radiographic images |
322 |
318 |
$70.14 |
| D0230 |
Intraoral - periapical each additional radiographic image |
615 |
570 |
$69.06 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$62.00 |
| D1110 |
Prophylaxis - adult |
51 |
50 |
$54.88 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
15 |
15 |
$0.00 |
| 90707 |
|
60 |
60 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
104 |
101 |
$0.00 |
| 90648 |
|
291 |
279 |
$0.00 |
| 90633 |
|
161 |
161 |
$0.00 |
| 90661 |
|
501 |
500 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
26 |
$0.00 |
| 91300 |
|
134 |
132 |
$0.00 |
| 90700 |
|
69 |
69 |
$0.00 |
| 90715 |
|
152 |
151 |
$0.00 |
| 90710 |
|
66 |
66 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
739 |
695 |
$0.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
28 |
$0.00 |
| 99173 |
|
459 |
458 |
$0.00 |
| 90681 |
|
185 |
180 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
14 |
12 |
$0.00 |
| 90473 |
|
17 |
17 |
$0.00 |
| D0603 |
|
1,268 |
1,216 |
$0.00 |
| D0602 |
|
2,148 |
2,101 |
$0.00 |
| 90619 |
|
77 |
77 |
$0.00 |
| 91307 |
|
334 |
329 |
$0.00 |
| 90716 |
|
61 |
61 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
218 |
213 |
$0.00 |
| 91301 |
|
14 |
14 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,289 |
1,269 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
304 |
290 |
$0.00 |
| 90696 |
|
24 |
24 |
$0.00 |
| 90698 |
|
107 |
105 |
$0.00 |
| 90677 |
|
423 |
415 |
$0.00 |
| 90723 |
|
214 |
208 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| 91318 |
|
12 |
12 |
$0.00 |
| 90656 |
|
256 |
255 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
202 |
196 |
$0.00 |
| 90651 |
|
84 |
78 |
$0.00 |
| 92551 |
|
421 |
419 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
12 |
12 |
$0.00 |
| 90620 |
|
64 |
63 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
15 |
$0.00 |
| 0011A |
|
14 |
14 |
$0.00 |
| 99383 |
|
28 |
28 |
$0.00 |
| D1351 |
Sealant - per tooth |
44 |
15 |
$0.00 |
| 90680 |
|
24 |
24 |
$0.00 |
| 90381 |
|
29 |
29 |
$0.00 |
| 90474 |
|
71 |
71 |
$0.00 |