| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,444 |
20,674 |
$3.53M |
| 00003 |
Internal/system code - not a standard HCPCS code |
4,609 |
3,946 |
$977K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,756 |
9,469 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,200 |
3,143 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
263 |
262 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
23 |
12 |
$0.00 |
| D1330 |
|
59 |
42 |
$0.00 |
| 99381 |
|
12 |
12 |
$0.00 |
| G9008 |
Coordinated care fee, physician coordinated care oversight services |
90 |
73 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
62 |
62 |
$0.00 |
| 92551 |
|
12 |
12 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |
| 99383 |
|
24 |
24 |
$0.00 |
| D1310 |
|
46 |
29 |
$0.00 |
| TB032 |
|
36 |
29 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
515 |
514 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
931 |
920 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,327 |
1,308 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,088 |
1,077 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
657 |
655 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
71 |
71 |
$0.00 |
| 92015 |
Determination of refractive state |
936 |
931 |
$0.00 |
| 90461 |
|
86 |
86 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
179 |
178 |
$0.00 |
| 92552 |
|
42 |
42 |
$0.00 |
| 99173 |
|
103 |
103 |
$0.00 |
| D1120 |
Prophylaxis - child |
24 |
12 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
52 |
47 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
30 |
30 |
$0.00 |
| D9993 |
|
14 |
14 |
$0.00 |