| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,165 |
1,944 |
$886K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,409 |
1,225 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
564 |
502 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
376 |
373 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
41 |
41 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
55 |
55 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
237 |
234 |
$629.74 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
23 |
21 |
$618.64 |
| 3008F |
|
71 |
70 |
$601.00 |
| 92587 |
|
117 |
106 |
$496.84 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
56 |
55 |
$405.81 |
| 90473 |
|
25 |
25 |
$299.48 |
| 99429 |
|
18 |
18 |
$180.00 |
| 92551 |
|
22 |
20 |
$127.14 |
| 81002 |
|
81 |
80 |
$102.06 |
| 90686 |
|
17 |
17 |
$87.58 |
| 90660 |
|
22 |
22 |
$23.46 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
114 |
$0.00 |
| 90619 |
|
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
32 |
26 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,281 |
1,320 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
136 |
$0.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| 90672 |
|
21 |
18 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
14 |
14 |
$0.00 |