| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,477 |
3,939 |
$713K |
| D0999 |
Unspecified diagnostic procedure, by report |
170 |
161 |
$17K |
| 96127 |
|
2,407 |
1,649 |
$1.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,498 |
1,352 |
$1.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,728 |
1,292 |
$1.00 |
| Q3014 |
Telehealth originating site facility fee |
789 |
676 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
197 |
175 |
$0.00 |
| 90686 |
|
564 |
539 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
493 |
453 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
314 |
291 |
$0.00 |
| 92551 |
|
882 |
809 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
42 |
$0.00 |
| 90651 |
|
26 |
25 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
91 |
83 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| 99384 |
|
12 |
12 |
$0.00 |
| 90620 |
|
15 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| 99173 |
|
1,076 |
992 |
$0.00 |
| 81002 |
|
621 |
552 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
611 |
559 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
205 |
196 |
$0.00 |
| 92552 |
|
146 |
145 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
24 |
24 |
$0.00 |
| 90633 |
|
17 |
14 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
27 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
41 |
41 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
30 |
30 |
$0.00 |
| 81025 |
|
16 |
13 |
$0.00 |