| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,914 |
5,508 |
$3.10M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,609 |
1,242 |
$44K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
472 |
220 |
$33K |
| 96153 |
|
445 |
173 |
$25K |
| T1017 |
Targeted case management, each 15 minutes |
283 |
230 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
680 |
525 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
187 |
170 |
$9K |
| D1206 |
Topical application of fluoride varnish |
482 |
470 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
310 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
583 |
505 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
276 |
269 |
$6K |
| D1120 |
Prophylaxis - child |
79 |
79 |
$2K |
| D1110 |
Prophylaxis - adult |
56 |
54 |
$1K |
| 94760 |
|
723 |
505 |
$1K |
| D0274 |
Bitewings - four radiographic images |
111 |
108 |
$953.99 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
62 |
62 |
$923.75 |
| 0002A |
|
20 |
20 |
$720.00 |
| 0001A |
|
23 |
22 |
$720.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$629.29 |
| 0011A |
|
85 |
81 |
$592.90 |
| 92587 |
|
52 |
50 |
$548.08 |
| 0071A |
|
14 |
14 |
$480.00 |
| 0064A |
|
14 |
13 |
$320.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
24 |
13 |
$205.87 |
| 36415 |
Collection of venous blood by venipuncture |
17 |
13 |
$38.72 |
| D0190 |
|
313 |
290 |
$0.00 |
| D0191 |
|
91 |
90 |
$0.00 |
| 91300 |
|
43 |
24 |
$0.00 |
| 99173 |
|
50 |
49 |
$0.00 |
| 91306 |
|
14 |
13 |
$0.00 |
| D1330 |
|
70 |
69 |
$0.00 |
| Q2039 |
Influenza virus vaccine, not otherwise specified |
54 |
54 |
$0.00 |
| 91307 |
|
14 |
14 |
$0.00 |
| 91301 |
|
95 |
90 |
$0.00 |
| T1002 |
Rn services, up to 15 minutes |
38 |
38 |
$0.00 |