| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,812 |
27,346 |
$13.30M |
| T1016 |
Case management, each 15 minutes |
1,454 |
956 |
$33K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
11,503 |
9,887 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
534 |
502 |
$86.35 |
| 0002A |
|
197 |
195 |
$68.34 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,757 |
7,665 |
$48.85 |
| 0012A |
|
172 |
170 |
$40.00 |
| 99215 |
Prolong outpt/office vis |
142 |
139 |
$38.48 |
| 0011A |
|
172 |
172 |
$33.88 |
| 36415 |
Collection of venous blood by venipuncture |
199 |
171 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
449 |
431 |
$0.00 |
| 82962 |
|
367 |
277 |
$0.00 |
| D0603 |
|
46 |
45 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
192 |
155 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
290 |
278 |
$0.00 |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
422 |
419 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
223 |
223 |
$0.00 |
| 99384 |
|
26 |
26 |
$0.00 |
| 0001A |
|
250 |
248 |
$0.00 |
| 0072A |
|
56 |
56 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
32 |
25 |
$0.00 |
| 91301 |
|
13 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$0.00 |
| 96154 |
|
13 |
13 |
$0.00 |
| 99385 |
|
12 |
12 |
$0.00 |
| 99383 |
|
15 |
15 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
318 |
297 |
$0.00 |
| 96152 |
|
529 |
411 |
$0.00 |
| 0071A |
|
111 |
109 |
$0.00 |
| 96158 |
|
731 |
676 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
510 |
$0.00 |
| 99173 |
|
16 |
16 |
$0.00 |
| 97803 |
|
21 |
20 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
278 |
268 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
121 |
121 |
$0.00 |
| D0270 |
|
49 |
49 |
$0.00 |
| 96167 |
|
33 |
33 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
96 |
96 |
$0.00 |
| 81002 |
|
158 |
139 |
$0.00 |
| 81025 |
|
96 |
94 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
75 |
74 |
$0.00 |
| 90461 |
|
27 |
27 |
$0.00 |
| 0013A |
|
28 |
25 |
$0.00 |
| 91300 |
|
31 |
31 |
$0.00 |
| 0003A |
|
94 |
85 |
$0.00 |
| D1120 |
Prophylaxis - child |
52 |
52 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
17 |
17 |
$0.00 |