| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,021 |
2,348 |
$1.13M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,567 |
2,119 |
$438K |
| 90837 |
Psychotherapy, 53 minutes with patient |
927 |
398 |
$158K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
853 |
690 |
$125K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
30 |
27 |
$8K |
| 0071A |
|
342 |
206 |
$6K |
| 0072A |
|
265 |
160 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
12 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
175 |
$2K |
| D1110 |
Prophylaxis - adult |
88 |
78 |
$2K |
| 0001A |
|
152 |
92 |
$2K |
| 0002A |
|
128 |
82 |
$2K |
| D0330 |
Panoramic radiographic image |
128 |
115 |
$2K |
| 0004A |
|
106 |
86 |
$2K |
| 0012A |
|
31 |
31 |
$1K |
| 0053A |
|
33 |
22 |
$864.78 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
100 |
93 |
$416.39 |
| D0274 |
Bitewings - four radiographic images |
92 |
89 |
$395.00 |
| 0011A |
|
12 |
12 |
$342.25 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
163 |
126 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$0.00 |
| 91300 |
|
17 |
17 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
14 |
14 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
735 |
708 |
$0.00 |
| 99000 |
|
618 |
539 |
$0.00 |
| 90686 |
|
102 |
101 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
320 |
279 |
$0.00 |
| 91307 |
|
157 |
155 |
$0.00 |
| 90688 |
|
44 |
44 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
43 |
42 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$0.00 |