| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,044 |
1,381 |
$446K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
393 |
315 |
$717.78 |
| 0001A |
|
16 |
16 |
$596.64 |
| 91300 |
|
36 |
31 |
$195.34 |
| D1110 |
Prophylaxis - adult |
37 |
37 |
$0.00 |
| 99188 |
|
134 |
134 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
36 |
35 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
15 |
$0.00 |
| D1120 |
Prophylaxis - child |
131 |
120 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
235 |
221 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
74 |
69 |
$0.00 |