| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
984 |
838 |
$29K |
| D1330 |
|
467 |
464 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
111 |
110 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
132 |
120 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
626 |
587 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
43 |
42 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
67 |
67 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
71 |
71 |
$2K |
| D1110 |
Prophylaxis - adult |
89 |
89 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
44 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
220 |
215 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$880.54 |
| 92552 |
|
41 |
37 |
$660.38 |
| 99173 |
|
385 |
351 |
$376.03 |
| 36415 |
Collection of venous blood by venipuncture |
130 |
126 |
$194.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
44 |
$175.68 |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
46 |
$153.14 |
| 92551 |
|
339 |
325 |
$148.61 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$119.18 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$85.12 |
| D1206 |
Topical application of fluoride varnish |
102 |
102 |
$63.15 |
| 1036F |
|
30 |
30 |
$0.00 |
| 1000F |
|
41 |
41 |
$0.00 |