| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
13,067 |
11,649 |
$2.93M |
| D0999 |
Unspecified diagnostic procedure, by report |
2,014 |
1,708 |
$583K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,432 |
2,380 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,791 |
7,095 |
$6K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
139 |
138 |
$1K |
| 90686 |
|
871 |
860 |
$801.77 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
112 |
104 |
$800.30 |
| 0011A |
|
27 |
27 |
$785.82 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
133 |
132 |
$740.21 |
| 0012A |
|
16 |
16 |
$525.00 |
| 0072A |
|
16 |
16 |
$450.00 |
| 0074A |
|
13 |
13 |
$300.00 |
| 36415 |
Collection of venous blood by venipuncture |
382 |
366 |
$243.60 |
| 0001A |
|
12 |
12 |
$240.00 |
| 0134A |
|
13 |
13 |
$240.00 |
| 90480 |
|
18 |
18 |
$70.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
82 |
82 |
$34.33 |
| 80305 |
|
14 |
13 |
$7.18 |
| 3079F |
|
376 |
353 |
$0.00 |
| 3074F |
|
2,149 |
2,000 |
$0.00 |
| 2001F |
|
2,755 |
2,541 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
342 |
341 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
930 |
880 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
119 |
119 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
68 |
68 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
51 |
$0.00 |
| 91301 |
|
48 |
48 |
$0.00 |
| 91307 |
|
33 |
33 |
$0.00 |
| 1111F |
|
425 |
404 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
50 |
$0.00 |
| 90656 |
|
38 |
38 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$0.00 |
| 3075F |
|
17 |
17 |
$0.00 |
| D1110 |
Prophylaxis - adult |
537 |
526 |
$0.00 |
| 1159F |
|
1,515 |
1,408 |
$0.00 |
| 3078F |
|
1,867 |
1,748 |
$0.00 |
| 90672 |
|
39 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
187 |
181 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
901 |
851 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
348 |
347 |
$0.00 |
| D0330 |
Panoramic radiographic image |
101 |
101 |
$0.00 |
| 91322 |
|
17 |
17 |
$0.00 |
| 4004F |
|
196 |
176 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
51 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
18 |
17 |
$0.00 |
| G8753 |
Most recent systolic blood pressure >= 140 mmhg |
17 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
104 |
$0.00 |
| 91300 |
|
79 |
73 |
$0.00 |
| 3077F |
|
17 |
15 |
$0.00 |
| 86703 |
|
30 |
30 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
614 |
597 |
$-337.59 |