| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,659 |
2,407 |
$643K |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,345 |
1,953 |
$522K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,304 |
1,223 |
$338K |
| D0999 |
Unspecified diagnostic procedure, by report |
575 |
532 |
$128K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
28 |
28 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
24 |
24 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
27 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
53 |
$126.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
38 |
$121.00 |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$78.00 |
| 81025 |
|
142 |
132 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
81 |
81 |
$0.00 |
| 81003 |
|
106 |
96 |
$0.00 |
| 99000 |
|
1,559 |
1,454 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
141 |
141 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$0.00 |
| D0602 |
|
54 |
54 |
$0.00 |