| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
449 |
421 |
$85K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,076 |
2,892 |
$54K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
863 |
824 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
70 |
45 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
63 |
61 |
$3K |
| 99441 |
|
226 |
211 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
74 |
72 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
27 |
$1K |
| 90656 |
|
45 |
45 |
$550.41 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
37 |
37 |
$438.19 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
12 |
$333.00 |
| 90688 |
|
17 |
17 |
$315.49 |
| 90686 |
|
29 |
28 |
$243.29 |
| 99442 |
|
12 |
12 |
$177.86 |
| 99429 |
|
177 |
173 |
$84.00 |
| 90674 |
|
18 |
18 |
$30.10 |