| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,001 |
1,675 |
$339K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,695 |
1,581 |
$318K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
794 |
696 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
212 |
204 |
$15K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
267 |
250 |
$12K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
150 |
126 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
145 |
138 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
85 |
84 |
$6K |
| 99000 |
|
196 |
185 |
$800.66 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
727 |
396 |
$772.28 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
465 |
443 |
$123.75 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
491 |
281 |
$41.52 |
| 96160 |
|
141 |
131 |
$15.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,064 |
1,040 |
$0.00 |
| D0603 |
|
526 |
520 |
$0.00 |
| 3008F |
|
391 |
354 |
$0.00 |
| D0602 |
|
213 |
210 |
$0.00 |
| 1036F |
|
16 |
14 |
$0.00 |
| 90677 |
|
78 |
75 |
$0.00 |
| 90680 |
|
26 |
26 |
$0.00 |
| 1126F |
|
169 |
156 |
$0.00 |
| 96161 |
|
28 |
25 |
$0.00 |
| 90474 |
|
12 |
12 |
$0.00 |
| 96127 |
|
151 |
134 |
$0.00 |
| 3074F |
|
353 |
313 |
$0.00 |
| 90656 |
|
134 |
134 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
73 |
70 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
95 |
95 |
$0.00 |
| 92551 |
|
117 |
106 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
14 |
$0.00 |
| 90697 |
|
12 |
12 |
$0.00 |
| 3725F |
|
65 |
59 |
$0.00 |
| 99173 |
|
212 |
198 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
385 |
379 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
143 |
139 |
$0.00 |
| 92552 |
|
16 |
15 |
$0.00 |
| D1120 |
Prophylaxis - child |
158 |
156 |
$0.00 |
| 3078F |
|
343 |
304 |
$0.00 |