| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
19,725 |
15,274 |
$5.22M |
| 0502F |
|
1,075 |
861 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,499 |
5,706 |
$1K |
| 3074F |
|
6,016 |
5,236 |
$423.95 |
| 3079F |
|
1,716 |
1,604 |
$270.00 |
| 3078F |
|
4,671 |
4,077 |
$228.95 |
| 99429 |
|
39 |
38 |
$100.00 |
| 3075F |
|
308 |
290 |
$60.00 |
| 1036F |
|
5,856 |
5,077 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
164 |
161 |
$0.00 |
| 88142 |
|
254 |
252 |
$0.00 |
| 0501F |
|
1,156 |
937 |
$0.00 |
| 2001F |
|
1,219 |
1,104 |
$0.00 |
| 3008F |
|
2,093 |
1,929 |
$0.00 |
| 90688 |
|
25 |
24 |
$0.00 |
| 92551 |
|
62 |
62 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
400 |
382 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
366 |
346 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
19 |
$0.00 |
| D1330 |
|
72 |
68 |
$0.00 |
| 82962 |
|
12 |
12 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
17 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
33 |
33 |
$0.00 |
| D0603 |
|
17 |
17 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
18 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
16 |
16 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
49 |
48 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
12 |
12 |
$0.00 |
| 1159F |
|
3,179 |
2,664 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
12 |
12 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
167 |
167 |
$0.00 |
| 81025 |
|
300 |
294 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
331 |
329 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
62 |
60 |
$0.00 |
| 99173 |
|
69 |
69 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
46 |
46 |
$0.00 |
| 90756 |
|
12 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
23 |
22 |
$0.00 |
| 3077F |
|
26 |
25 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| 90461 |
|
49 |
49 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
145 |
145 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14 |
14 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$0.00 |
| D9110 |
|
34 |
32 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
47 |
44 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
23 |
20 |
$0.00 |