| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,045 |
1,904 |
$53K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,490 |
4,330 |
$42K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,211 |
2,031 |
$31K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,344 |
1,269 |
$22K |
| 99215 |
Prolong outpt/office vis |
154 |
142 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
155 |
130 |
$11K |
| 99201 |
|
247 |
236 |
$7K |
| 92552 |
|
1,181 |
1,093 |
$7K |
| H1000 |
Prenatal care, at-risk assessment |
88 |
84 |
$6K |
| 99173 |
|
1,313 |
1,223 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
321 |
243 |
$5K |
| 86703 |
|
308 |
282 |
$3K |
| D1120 |
Prophylaxis - child |
142 |
123 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
373 |
364 |
$3K |
| 90686 |
|
2,753 |
2,665 |
$3K |
| D1206 |
Topical application of fluoride varnish |
176 |
156 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
63 |
$2K |
| 90715 |
|
380 |
352 |
$2K |
| 81025 |
|
252 |
217 |
$1K |
| 0012A |
|
98 |
80 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
35 |
26 |
$934.10 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$920.77 |
| 0071A |
|
24 |
24 |
$920.00 |
| 86580 |
|
141 |
127 |
$913.19 |
| D0140 |
Limited oral evaluation - problem focused |
32 |
30 |
$646.01 |
| 90734 |
|
211 |
187 |
$632.27 |
| 90651 |
|
111 |
104 |
$614.61 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
12 |
$533.05 |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
52 |
$473.86 |
| 0001A |
|
16 |
12 |
$363.05 |
| 90619 |
|
346 |
337 |
$357.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
32 |
$241.74 |
| 0011A |
|
64 |
61 |
$230.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$228.92 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$208.26 |
| D0274 |
Bitewings - four radiographic images |
16 |
15 |
$177.24 |
| 90656 |
|
32 |
32 |
$100.00 |
| 90710 |
|
182 |
177 |
$0.00 |
| 90633 |
|
176 |
165 |
$0.00 |
| D0190 |
|
14 |
14 |
$0.00 |
| 90696 |
|
59 |
56 |
$0.00 |
| 90620 |
|
63 |
61 |
$0.00 |
| D1330 |
|
139 |
132 |
$0.00 |