| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
769 |
651 |
$48K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
514 |
447 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
296 |
295 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
390 |
388 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
53 |
45 |
$3K |
| D1110 |
Prophylaxis - adult |
176 |
176 |
$3K |
| D0330 |
Panoramic radiographic image |
307 |
306 |
$3K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
32 |
29 |
$3K |
| D1206 |
Topical application of fluoride varnish |
234 |
233 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
25 |
25 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
21 |
21 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
176 |
159 |
$771.12 |
| 99383 |
|
14 |
13 |
$759.59 |
| D1330 |
|
265 |
264 |
$666.26 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
63 |
62 |
$463.92 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
50 |
50 |
$426.92 |
| 36415 |
Collection of venous blood by venipuncture |
333 |
308 |
$287.00 |
| 3074F |
|
741 |
635 |
$250.00 |
| 81025 |
|
88 |
75 |
$244.75 |
| 85018 |
|
162 |
160 |
$136.55 |
| 83655 |
|
32 |
32 |
$134.14 |
| D1120 |
Prophylaxis - child |
17 |
16 |
$134.06 |
| 82962 |
|
53 |
47 |
$59.35 |
| 3075F |
|
15 |
12 |
$25.00 |
| D0603 |
|
97 |
97 |
$10.00 |
| 1160F |
|
478 |
378 |
$0.00 |
| 99173 |
|
74 |
71 |
$0.00 |
| 3078F |
|
600 |
523 |
$0.00 |
| 1159F |
|
477 |
378 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
14 |
13 |
$0.00 |
| 2000F |
|
942 |
793 |
$0.00 |
| 2001F |
|
1,088 |
907 |
$0.00 |
| 1000F |
|
448 |
378 |
$0.00 |
| 3008F |
|
1,008 |
859 |
$0.00 |
| 1126F |
|
296 |
255 |
$0.00 |
| 3079F |
|
135 |
118 |
$0.00 |
| 1220F |
|
208 |
181 |
$0.00 |
| 36416 |
|
16 |
14 |
$0.00 |
| 3044F |
|
134 |
121 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
14 |
13 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |