| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
23,288 |
20,428 |
$3.86M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,652 |
6,097 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,120 |
2,001 |
$2K |
| 92551 |
|
1,909 |
1,896 |
$703.48 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
482 |
478 |
$611.26 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,082 |
1,077 |
$556.58 |
| 90670 |
|
360 |
359 |
$528.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,169 |
1,163 |
$466.83 |
| 3074F |
|
1,961 |
1,890 |
$260.00 |
| 3078F |
|
1,693 |
1,635 |
$220.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,244 |
1,224 |
$134.68 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,025 |
936 |
$126.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,143 |
2,133 |
$118.53 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
620 |
601 |
$60.88 |
| 3079F |
|
478 |
464 |
$40.00 |
| 3075F |
|
131 |
127 |
$10.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,253 |
1,248 |
$0.03 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
756 |
751 |
$0.00 |
| 90723 |
|
189 |
189 |
$0.00 |
| 96127 |
|
798 |
793 |
$0.00 |
| 96161 |
|
377 |
369 |
$0.00 |
| 90680 |
|
118 |
118 |
$0.00 |
| 90647 |
|
204 |
204 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,192 |
3,081 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
114 |
114 |
$0.00 |
| 90677 |
|
123 |
123 |
$0.00 |
| 90674 |
|
141 |
139 |
$0.00 |
| 90651 |
|
28 |
28 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
27 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
205 |
205 |
$0.00 |
| 90474 |
|
68 |
68 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
93 |
$0.00 |
| 85018 |
|
90 |
90 |
$0.00 |
| 90686 |
|
145 |
145 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| 90682 |
|
24 |
24 |
$0.00 |
| 90734 |
|
41 |
41 |
$0.00 |
| D1110 |
Prophylaxis - adult |
128 |
128 |
$0.00 |
| 3288F |
|
344 |
343 |
$0.00 |
| 99173 |
|
1,778 |
1,766 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
201 |
201 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
50 |
50 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
61 |
60 |
$0.00 |
| 90633 |
|
38 |
38 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
81 |
$0.00 |
| 90715 |
|
24 |
24 |
$0.00 |
| 81002 |
|
61 |
53 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
47 |
47 |
$0.00 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
76 |
75 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
358 |
357 |
$0.00 |
| 83655 |
|
57 |
57 |
$0.00 |
| D1120 |
Prophylaxis - child |
128 |
128 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
27 |
27 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$0.00 |
| 90661 |
|
23 |
23 |
$0.00 |