| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0100 |
Non-emergency transportation; taxi |
18 |
17 |
$5K |
| 90834 |
Psychotherapy, 45 minutes with patient |
682 |
356 |
$0.00 |
| H2035 |
Alcohol and/or other drug treatment program, per hour |
928 |
514 |
$0.00 |
| D1351 |
Sealant - per tooth |
587 |
495 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,634 |
2,173 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,055 |
1,942 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
723 |
673 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,019 |
1,414 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
241 |
191 |
$0.00 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
150 |
85 |
$0.00 |
| 97804 |
|
273 |
64 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
32 |
16 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |
| D0240 |
|
17 |
16 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
23,383 |
13,384 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
550 |
482 |
$0.00 |
| 99408 |
|
265 |
87 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
8,852 |
4,502 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
889 |
501 |
$0.00 |
| D1110 |
Prophylaxis - adult |
355 |
298 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,116 |
2,965 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
3,743 |
1,519 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
288 |
154 |
$0.00 |
| D0190 |
|
221 |
178 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
60 |
15 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
61 |
36 |
$0.00 |
| H0036 |
Community psychiatric supportive treatment, face-to-face, per 15 minutes |
147 |
13 |
$0.00 |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
29 |
29 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
14 |
$0.00 |
| H0047 |
Alcohol and/or other drug abuse services, not otherwise specified |
23 |
12 |
$0.00 |