| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,974 |
10,978 |
$196K |
| T1015 |
Clinic visit/encounter, all-inclusive |
895 |
686 |
$137K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,602 |
4,934 |
$98K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,714 |
2,613 |
$59K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
1,271 |
474 |
$38K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,613 |
2,581 |
$31K |
| 99215 |
Prolong outpt/office vis |
878 |
831 |
$25K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
954 |
949 |
$20K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
357 |
351 |
$17K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
217 |
217 |
$11K |
| 99223 |
Prolong inpt eval add15 m |
231 |
220 |
$8K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
324 |
306 |
$7K |
| 11721 |
|
337 |
336 |
$6K |
| 99173 |
|
1,524 |
1,497 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
539 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
120 |
120 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
44 |
42 |
$4K |
| 81025 |
|
1,357 |
1,266 |
$3K |
| 92551 |
|
480 |
456 |
$3K |
| 11056 |
|
204 |
203 |
$2K |
| D0330 |
Panoramic radiographic image |
332 |
329 |
$2K |
| 90656 |
|
336 |
335 |
$2K |
| 90686 |
|
529 |
517 |
$2K |
| 90658 |
|
130 |
128 |
$1K |
| D0274 |
Bitewings - four radiographic images |
154 |
148 |
$639.00 |
| 0011A |
|
24 |
24 |
$604.17 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
48 |
$602.00 |
| D1110 |
Prophylaxis - adult |
65 |
64 |
$578.00 |
| D1120 |
Prophylaxis - child |
50 |
50 |
$546.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
15 |
$532.00 |
| 0012A |
|
13 |
13 |
$480.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$449.61 |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$330.00 |
| 3008F |
|
4,714 |
4,126 |
$248.00 |
| 36415 |
Collection of venous blood by venipuncture |
95 |
92 |
$217.06 |
| 1159F |
|
6,314 |
5,431 |
$180.00 |
| 3078F |
|
1,993 |
1,891 |
$175.25 |
| 0064A |
|
15 |
15 |
$160.00 |
| 3074F |
|
1,595 |
1,534 |
$154.14 |
| 1126F |
|
2,050 |
1,845 |
$150.26 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$137.57 |
| 97802 |
|
2,257 |
2,065 |
$116.25 |
| 90651 |
|
56 |
55 |
$108.00 |
| 1125F |
|
994 |
906 |
$99.21 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$90.00 |
| 99406 |
|
294 |
280 |
$61.00 |
| 3079F |
|
533 |
520 |
$59.00 |
| 3044F |
|
504 |
491 |
$55.05 |
| 3077F |
|
489 |
466 |
$55.00 |
| 1170F |
|
663 |
607 |
$29.01 |
| 96127 |
|
83 |
83 |
$28.00 |
| 3075F |
|
322 |
311 |
$25.00 |
| 91301 |
|
41 |
41 |
$18.00 |
| 3061F |
|
89 |
89 |
$5.00 |
| 3080F |
|
45 |
44 |
$4.00 |
| 91306 |
|
15 |
15 |
$1.00 |
| 3514F |
|
1,034 |
966 |
$0.00 |
| 3292F |
|
1,707 |
1,564 |
$0.00 |
| 1220F |
|
2,916 |
2,683 |
$0.00 |
| 3014F |
|
627 |
591 |
$0.00 |
| 4000F |
|
417 |
393 |
$0.00 |
| 4210F |
|
513 |
471 |
$0.00 |
| 3017F |
|
261 |
247 |
$0.00 |
| 3048F |
|
444 |
422 |
$0.00 |
| 3049F |
|
28 |
24 |
$0.00 |
| 3015F |
|
744 |
665 |
$0.00 |
| 3050F |
|
30 |
26 |
$0.00 |