| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,393 |
11,231 |
$6.28M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,371 |
5,033 |
$248K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
520 |
450 |
$35K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,113 |
911 |
$25K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
284 |
256 |
$13K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
348 |
302 |
$10K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
77 |
72 |
$6K |
| 90688 |
|
417 |
355 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
549 |
495 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
59 |
56 |
$3K |
| 99443 |
|
39 |
37 |
$2K |
| 0012A |
|
72 |
71 |
$2K |
| 99442 |
|
39 |
37 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
26 |
$1K |
| 0002A |
|
28 |
28 |
$1K |
| 0071A |
|
30 |
30 |
$1K |
| 0072A |
|
32 |
31 |
$1K |
| 0011A |
|
84 |
81 |
$932.54 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$884.67 |
| 0064A |
|
30 |
30 |
$880.00 |
| 90686 |
|
93 |
74 |
$732.87 |
| 36415 |
Collection of venous blood by venipuncture |
92 |
76 |
$506.34 |
| 0001A |
|
12 |
12 |
$450.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
59 |
57 |
$430.51 |
| 90658 |
|
28 |
27 |
$393.62 |
| 90480 |
|
25 |
24 |
$324.22 |
| D1206 |
Topical application of fluoride varnish |
60 |
47 |
$245.24 |
| 92551 |
|
25 |
25 |
$183.60 |
| 99173 |
|
99 |
93 |
$159.20 |
| 87275 |
|
12 |
12 |
$148.83 |
| 87276 |
|
12 |
12 |
$148.83 |
| 90651 |
|
17 |
17 |
$82.72 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$67.94 |
| 90687 |
|
43 |
42 |
$29.85 |
| D0120 |
Periodic oral evaluation - established patient |
45 |
39 |
$29.46 |
| 91322 |
|
37 |
35 |
$0.27 |
| 96165 |
|
193 |
43 |
$0.00 |
| 91300 |
|
73 |
72 |
$0.00 |
| 96153 |
|
325 |
86 |
$0.00 |
| D1120 |
Prophylaxis - child |
21 |
17 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
21 |
18 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$0.00 |
| 91307 |
|
98 |
95 |
$0.00 |
| 91301 |
|
316 |
304 |
$0.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
35 |
25 |
$0.00 |
| 96164 |
|
197 |
43 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
13 |
$0.00 |
| D1330 |
|
20 |
15 |
$0.00 |