| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,022 |
4,074 |
$345K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,185 |
5,679 |
$220K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
876 |
688 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
273 |
189 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
199 |
142 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,767 |
1,596 |
$7K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
622 |
580 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
127 |
95 |
$5K |
| D1120 |
Prophylaxis - child |
357 |
216 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
313 |
202 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
308 |
$3K |
| D1206 |
Topical application of fluoride varnish |
115 |
108 |
$2K |
| 90651 |
|
40 |
39 |
$1K |
| 92551 |
|
603 |
530 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
57 |
40 |
$1K |
| 90686 |
|
273 |
259 |
$901.36 |
| 99173 |
|
584 |
513 |
$451.20 |
| D1110 |
Prophylaxis - adult |
26 |
14 |
$375.43 |
| D0274 |
Bitewings - four radiographic images |
18 |
16 |
$373.00 |
| 90734 |
|
38 |
36 |
$246.76 |
| 90688 |
|
126 |
123 |
$213.93 |
| 90619 |
|
46 |
44 |
$150.53 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13 |
13 |
$87.42 |
| 90656 |
|
13 |
13 |
$44.65 |
| 90715 |
|
40 |
38 |
$35.80 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
12 |
12 |
$7.13 |
| 3008F |
|
3,056 |
2,440 |
$0.00 |
| D0603 |
|
150 |
130 |
$0.00 |
| D0602 |
|
34 |
31 |
$0.00 |
| 94760 |
|
76 |
72 |
$0.00 |
| 90649 |
|
12 |
12 |
$0.00 |