| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
548 |
405 |
$104K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,185 |
1,077 |
$25K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
138 |
138 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
28 |
27 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
62 |
58 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
13 |
13 |
$299.00 |
| 82947 |
|
89 |
78 |
$142.18 |
| 92551 |
|
13 |
13 |
$55.93 |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
69 |
$3.75 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
42 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
410 |
284 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$0.00 |