| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
39,278 |
30,042 |
$5.74M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,717 |
1,450 |
$173K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28,160 |
22,452 |
$368.48 |
| Q3014 |
Telehealth originating site facility fee |
3,985 |
3,542 |
$132.45 |
| 96127 |
|
20,200 |
15,145 |
$106.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
623 |
560 |
$1.00 |
| 81025 |
|
2,042 |
1,805 |
$1.00 |
| 92551 |
|
276 |
210 |
$0.00 |
| 3080F |
|
192 |
178 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
433 |
380 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
479 |
466 |
$0.00 |
| 1126F |
|
716 |
647 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,665 |
1,214 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
314 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
592 |
544 |
$0.00 |
| 3074F |
|
696 |
637 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
4,860 |
4,151 |
$0.00 |
| 90686 |
|
318 |
270 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
209 |
204 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
308 |
197 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
98 |
71 |
$0.00 |
| 3079F |
|
278 |
254 |
$0.00 |
| 3075F |
|
170 |
157 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
84 |
84 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
70 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
135 |
122 |
$0.00 |
| 1125F |
|
328 |
288 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
135 |
135 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
168 |
162 |
$0.00 |
| 97802 |
|
60 |
59 |
$0.00 |
| 90651 |
|
21 |
16 |
$0.00 |
| 90733 |
|
25 |
14 |
$0.00 |
| 99384 |
|
14 |
14 |
$0.00 |
| 99383 |
|
16 |
16 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,225 |
1,062 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,729 |
1,570 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
239 |
210 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
795 |
753 |
$0.00 |
| 81002 |
|
581 |
462 |
$0.00 |
| 90713 |
|
13 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
136 |
123 |
$0.00 |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
69 |
69 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
286 |
285 |
$0.00 |
| 99173 |
|
938 |
822 |
$0.00 |
| 90633 |
|
48 |
40 |
$0.00 |
| 0502F |
|
170 |
104 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
665 |
644 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
78 |
77 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$0.00 |
| 90734 |
|
117 |
102 |
$0.00 |
| 3078F |
|
523 |
480 |
$0.00 |
| D1120 |
Prophylaxis - child |
129 |
129 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |
| 97803 |
|
93 |
68 |
$0.00 |
| 90710 |
|
30 |
30 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$0.00 |
| 3077F |
|
89 |
78 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
52 |
$0.00 |
| 90715 |
|
41 |
33 |
$0.00 |