| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,901 |
10,669 |
$3.25M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,783 |
3,276 |
$71.60 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
571 |
541 |
$22.32 |
| 90686 |
|
238 |
223 |
$16.26 |
| 1160F |
|
1,426 |
1,241 |
$0.00 |
| 1159F |
|
1,426 |
1,242 |
$0.00 |
| 3077F |
|
29 |
27 |
$0.00 |
| 3078F |
|
438 |
399 |
$0.00 |
| 99173 |
|
62 |
62 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
26 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
18 |
18 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
29 |
$0.00 |
| 81002 |
|
16 |
15 |
$0.00 |
| D0190 |
|
21 |
21 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
17 |
15 |
$0.00 |
| 3008F |
|
761 |
694 |
$0.00 |
| 3079F |
|
336 |
303 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
25 |
25 |
$0.00 |
| 1111F |
|
1,407 |
1,226 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,516 |
1,277 |
$0.00 |
| 3074F |
|
754 |
665 |
$0.00 |
| 99000 |
|
77 |
75 |
$0.00 |
| 91301 |
|
97 |
59 |
$0.00 |
| D1330 |
|
17 |
17 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
22 |
22 |
$0.00 |
| 0011A |
|
29 |
29 |
$0.00 |
| 92551 |
|
40 |
40 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| D0603 |
|
17 |
17 |
$0.00 |
| 0012A |
|
12 |
12 |
$0.00 |