| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,782 |
4,783 |
$131K |
| H1000 |
Prenatal care, at-risk assessment |
334 |
217 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
370 |
336 |
$12K |
| 99442 |
|
163 |
148 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
1,687 |
1,327 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
68 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
65 |
62 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
197 |
$3K |
| D1110 |
Prophylaxis - adult |
118 |
118 |
$2K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
108 |
68 |
$2K |
| 3074F |
|
3,465 |
2,752 |
$2K |
| 90837 |
Psychotherapy, 53 minutes with patient |
17 |
13 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
16 |
14 |
$812.64 |
| 3078F |
|
3,054 |
2,311 |
$674.44 |
| D0120 |
Periodic oral evaluation - established patient |
77 |
59 |
$574.02 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
43 |
40 |
$501.75 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
22 |
18 |
$447.47 |
| 96127 |
|
111 |
101 |
$306.14 |
| D1330 |
|
284 |
254 |
$274.77 |
| 81025 |
|
112 |
81 |
$211.24 |
| 81002 |
|
254 |
174 |
$179.29 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
73 |
72 |
$160.00 |
| 99401 |
|
16 |
15 |
$139.01 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$100.20 |
| 3008F |
|
6,166 |
4,831 |
$75.66 |
| 80053 |
Comprehensive metabolic panel |
210 |
96 |
$53.61 |
| 99406 |
|
16 |
14 |
$52.56 |
| 1159F |
|
1,816 |
1,497 |
$50.44 |
| 1000F |
|
5,476 |
4,213 |
$50.44 |
| 3044F |
|
548 |
401 |
$37.83 |
| 1126F |
|
3,380 |
2,812 |
$37.83 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
414 |
369 |
$25.22 |
| 3351F |
|
551 |
309 |
$12.63 |
| 3725F |
|
333 |
305 |
$12.61 |
| 3079F |
|
350 |
276 |
$12.61 |
| 3352F |
|
293 |
180 |
$0.01 |
| 1033F |
|
811 |
746 |
$0.00 |
| 1160F |
|
1,577 |
1,273 |
$0.00 |
| 4004F |
|
12 |
12 |
$0.00 |
| 3050F |
|
19 |
12 |
$0.00 |
| 2000F |
|
4,572 |
3,464 |
$0.00 |
| 1220F |
|
4,731 |
3,904 |
$0.00 |
| 2001F |
|
6,543 |
5,051 |
$0.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
363 |
337 |
$0.00 |
| 1157F |
|
278 |
141 |
$0.00 |
| 1125F |
|
128 |
116 |
$0.00 |
| 3048F |
|
55 |
33 |
$0.00 |
| 3075F |
|
26 |
25 |
$0.00 |
| 4010F |
|
65 |
35 |
$0.00 |
| 3049F |
|
17 |
15 |
$0.00 |