| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,433 |
15,091 |
$3.39M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,598 |
8,206 |
$199K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,309 |
3,048 |
$83K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,159 |
1,087 |
$52K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,016 |
952 |
$45K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
956 |
892 |
$41K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,858 |
1,749 |
$35K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
776 |
699 |
$30K |
| 87428 |
|
1,240 |
1,171 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,224 |
3,034 |
$9K |
| D0999 |
Unspecified diagnostic procedure, by report |
61 |
51 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,243 |
1,173 |
$4K |
| 99381 |
|
49 |
41 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
81 |
70 |
$2K |
| 90461 |
|
2,776 |
1,900 |
$1K |
| 99383 |
|
27 |
27 |
$1K |
| 99384 |
|
16 |
15 |
$673.76 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
179 |
143 |
$646.56 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
112 |
88 |
$366.67 |
| 87807 |
|
84 |
77 |
$242.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$185.40 |
| 90619 |
|
153 |
140 |
$152.23 |
| 90686 |
|
949 |
908 |
$133.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
26 |
$84.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
12 |
$66.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$39.30 |
| 90633 |
|
270 |
252 |
$37.29 |
| 90715 |
|
88 |
83 |
$30.49 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$18.00 |
| 90656 |
|
72 |
70 |
$17.47 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
41 |
35 |
$13.90 |
| 90620 |
|
26 |
25 |
$0.08 |
| 92551 |
|
469 |
462 |
$0.01 |
| 90677 |
|
133 |
133 |
$0.01 |
| 1159F |
|
5,495 |
4,794 |
$0.00 |
| 3078F |
|
3,770 |
3,400 |
$0.00 |
| 90734 |
|
71 |
71 |
$0.00 |
| 90670 |
|
702 |
643 |
$0.00 |
| 90710 |
|
183 |
171 |
$0.00 |
| 1160F |
|
5,498 |
4,797 |
$0.00 |
| 3210F |
|
1,096 |
975 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
12 |
12 |
$0.00 |
| 4000F |
|
1,415 |
1,322 |
$0.00 |
| 3008F |
|
5,004 |
4,388 |
$0.00 |
| 99441 |
|
59 |
58 |
$0.00 |
| 1126F |
|
2,679 |
2,427 |
$0.00 |
| 2001F |
|
6,256 |
5,390 |
$0.00 |
| 3074F |
|
4,027 |
3,599 |
$0.00 |
| 1220F |
|
890 |
805 |
$0.00 |
| 3079F |
|
611 |
544 |
$0.00 |
| 1000F |
|
4,289 |
3,533 |
$0.00 |
| 2000F |
|
4,499 |
3,977 |
$0.00 |
| 90698 |
|
408 |
368 |
$0.00 |
| 1125F |
|
391 |
353 |
$0.00 |
| 90744 |
|
208 |
191 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
262 |
244 |
$0.00 |
| 90651 |
|
274 |
262 |
$0.00 |
| 90680 |
|
162 |
147 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
36 |
26 |
$0.00 |
| D1330 |
|
19 |
18 |
$0.00 |
| 3075F |
|
103 |
94 |
$0.00 |
| 3044F |
|
79 |
66 |
$0.00 |
| 90696 |
|
31 |
28 |
$0.00 |
| 90697 |
|
28 |
28 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| D0603 |
|
14 |
14 |
$0.00 |