| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,991 |
6,222 |
$902K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
587 |
557 |
$326.52 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,084 |
1,869 |
$70.00 |
| D0274 |
Bitewings - four radiographic images |
244 |
237 |
$0.00 |
| D1110 |
Prophylaxis - adult |
441 |
428 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
15 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
144 |
143 |
$0.00 |
| D0330 |
Panoramic radiographic image |
67 |
64 |
$0.00 |
| D1120 |
Prophylaxis - child |
122 |
113 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
34 |
33 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
50 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
496 |
483 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
13 |
$0.00 |
| 90688 |
|
170 |
125 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
235 |
221 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
79 |
18 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
66 |
66 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| 90656 |
|
27 |
27 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$0.00 |