| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,977 |
14,736 |
$3.17M |
| 99499 |
|
340 |
315 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,050 |
5,958 |
$4K |
| 0012A |
|
52 |
52 |
$2K |
| 0011A |
|
43 |
43 |
$2K |
| 3725F |
|
351 |
306 |
$420.00 |
| 3074F |
|
319 |
284 |
$260.00 |
| 3078F |
|
266 |
237 |
$250.00 |
| 3079F |
|
145 |
131 |
$170.00 |
| 3077F |
|
55 |
47 |
$130.00 |
| 3075F |
|
80 |
75 |
$100.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
70 |
70 |
$90.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
142 |
74 |
$54.42 |
| 3080F |
|
32 |
29 |
$30.00 |
| 90686 |
|
734 |
706 |
$10.00 |
| 92551 |
|
287 |
281 |
$8.00 |
| 99173 |
|
259 |
253 |
$6.00 |
| 96127 |
|
202 |
186 |
$3.60 |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
136 |
$0.00 |
| 1159F |
|
606 |
524 |
$0.00 |
| 82947 |
|
42 |
36 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,448 |
1,385 |
$0.00 |
| 90461 |
|
303 |
303 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
111 |
111 |
$0.00 |
| 1160F |
|
612 |
530 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$0.00 |
| 82948 |
|
108 |
100 |
$0.00 |
| 0502F |
|
70 |
50 |
$0.00 |
| D1110 |
Prophylaxis - adult |
64 |
63 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
33 |
32 |
$0.00 |
| 3008F |
|
628 |
550 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
372 |
367 |
$0.00 |
| 85018 |
|
28 |
28 |
$0.00 |
| 90651 |
|
13 |
12 |
$0.00 |
| 1036F |
|
356 |
300 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
52 |
51 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
48 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
14 |
14 |
$0.00 |
| 88150 |
|
17 |
17 |
$0.00 |
| 1034F |
|
128 |
108 |
$0.00 |
| 81000 |
|
79 |
56 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
43 |
42 |
$0.00 |
| S0612 |
Annual gynecological examination, established patient |
15 |
15 |
$0.00 |
| 19499 |
|
15 |
15 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |