| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,944 |
3,615 |
$681K |
| D0999 |
Unspecified diagnostic procedure, by report |
2,593 |
2,365 |
$271K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
207 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
548 |
325 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
782 |
516 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
221 |
159 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
555 |
342 |
$0.00 |
| 85018 |
|
835 |
515 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,312 |
1,879 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
136 |
78 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
185 |
110 |
$0.00 |
| 86592 |
|
336 |
182 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
814 |
503 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
410 |
268 |
$0.00 |
| 81000 |
|
198 |
105 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
275 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
706 |
409 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
578 |
335 |
$0.00 |
| 90651 |
|
62 |
29 |
$0.00 |
| 90686 |
|
577 |
384 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
200 |
199 |
$0.00 |
| 86780 |
|
31 |
30 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
36 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
124 |
124 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
33 |
29 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
30 |
13 |
$0.00 |
| 90461 |
|
138 |
90 |
$0.00 |
| 82947 |
|
178 |
106 |
$0.00 |
| 99173 |
|
468 |
305 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
82 |
64 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
315 |
231 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
231 |
132 |
$0.00 |
| 81025 |
|
787 |
467 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
412 |
400 |
$0.00 |
| 87660 |
|
541 |
283 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
510 |
$0.00 |
| 80061 |
Lipid panel |
379 |
235 |
$0.00 |
| D1120 |
Prophylaxis - child |
114 |
114 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
117 |
71 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
575 |
297 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
21 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
28 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
88 |
78 |
$0.00 |
| 90715 |
|
35 |
14 |
$0.00 |
| 83655 |
|
46 |
45 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
162 |
54 |
$0.00 |
| 90670 |
|
42 |
26 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
40 |
13 |
$0.00 |
| 90734 |
|
24 |
14 |
$0.00 |
| 90648 |
|
23 |
13 |
$0.00 |