| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,972 |
17,306 |
$3.66M |
| T1016 |
Case management, each 15 minutes |
2,827 |
1,660 |
$102K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
15 |
15 |
$14K |
| 59025 |
Fetal non-stress test |
163 |
122 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,508 |
1,317 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,424 |
3,723 |
$2K |
| 3008F |
|
1,039 |
796 |
$73.90 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
36 |
28 |
$44.86 |
| D0220 |
Intraoral - periapical first radiographic image |
1,032 |
896 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
123 |
116 |
$0.00 |
| D1120 |
Prophylaxis - child |
558 |
494 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
548 |
465 |
$0.00 |
| D1110 |
Prophylaxis - adult |
620 |
547 |
$0.00 |
| 3078F |
|
152 |
123 |
$0.00 |
| D0330 |
Panoramic radiographic image |
147 |
112 |
$0.00 |
| D0190 |
|
171 |
153 |
$0.00 |
| 1158F |
|
12 |
12 |
$0.00 |
| H0031 |
Mental health assessment, by non-physician |
13 |
13 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
362 |
325 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,045 |
914 |
$0.00 |
| 1170F |
|
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
975 |
874 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
538 |
481 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
189 |
186 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
220 |
$0.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
597 |
320 |
$0.00 |
| 3074F |
|
119 |
93 |
$0.00 |
| 3044F |
|
50 |
38 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
73 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
39 |
$0.00 |
| 3079F |
|
44 |
38 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
17 |
15 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
32 |
27 |
$0.00 |
| 3048F |
|
39 |
30 |
$0.00 |
| D0171 |
|
61 |
55 |
$0.00 |
| 1157F |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
54 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |
| 90686 |
|
15 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
12 |
$0.00 |