| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
29,245 |
21,879 |
$4.14M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,988 |
1,483 |
$118K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,412 |
8,496 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,735 |
2,331 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,561 |
4,705 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,053 |
992 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,108 |
1,039 |
$889.04 |
| 90686 |
|
334 |
295 |
$685.11 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
688 |
647 |
$332.67 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
964 |
872 |
$217.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
232 |
212 |
$211.68 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
284 |
272 |
$160.80 |
| 85018 |
|
1,182 |
1,084 |
$118.32 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
441 |
409 |
$111.67 |
| 82962 |
|
523 |
471 |
$94.56 |
| 81025 |
|
913 |
783 |
$87.09 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
71 |
70 |
$85.65 |
| 90658 |
|
1,073 |
1,026 |
$72.01 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
12 |
$47.12 |
| 90677 |
|
74 |
73 |
$33.42 |
| 81002 |
|
370 |
290 |
$31.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
168 |
147 |
$26.00 |
| 90688 |
|
13 |
13 |
$25.12 |
| 90619 |
|
83 |
77 |
$25.12 |
| 0502F |
|
379 |
247 |
$19.00 |
| 90648 |
|
67 |
58 |
$16.71 |
| 90661 |
|
57 |
53 |
$16.71 |
| 90651 |
|
85 |
82 |
$16.71 |
| 90723 |
|
13 |
12 |
$16.71 |
| 90744 |
|
39 |
38 |
$16.71 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
448 |
387 |
$15.00 |
| 90670 |
|
419 |
401 |
$15.00 |
| 99441 |
|
74 |
58 |
$15.00 |
| 90649 |
|
190 |
172 |
$10.00 |
| 90715 |
|
97 |
87 |
$6.00 |
| 90734 |
|
128 |
112 |
$5.00 |
| 90680 |
|
40 |
39 |
$4.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
232 |
148 |
$1.00 |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
63 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
775 |
702 |
$0.00 |
| 90461 |
|
368 |
335 |
$0.00 |
| D0330 |
Panoramic radiographic image |
273 |
240 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
42 |
42 |
$0.00 |
| 90633 |
|
132 |
124 |
$0.00 |
| 97803 |
|
74 |
58 |
$0.00 |
| 3077F |
|
276 |
235 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
162 |
152 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
229 |
180 |
$0.00 |
| 3078F |
|
452 |
401 |
$0.00 |
| 80061 |
Lipid panel |
26 |
22 |
$0.00 |
| 4145F |
|
132 |
122 |
$0.00 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$0.00 |
| 83655 |
|
15 |
14 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$0.00 |
| 2000F |
|
429 |
374 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$0.00 |
| 3080F |
|
99 |
88 |
$0.00 |
| 3074F |
|
517 |
456 |
$0.00 |
| 87070 |
|
90 |
81 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
53 |
39 |
$0.00 |
| 4010F |
|
134 |
128 |
$0.00 |
| 3008F |
|
1,642 |
1,403 |
$0.00 |
| 1036F |
|
570 |
512 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
38 |
$0.00 |
| 90698 |
|
85 |
82 |
$0.00 |
| 90620 |
|
34 |
32 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
295 |
279 |
$0.00 |
| 3075F |
|
95 |
85 |
$0.00 |
| 3079F |
|
374 |
336 |
$0.00 |
| 3044F |
|
14 |
14 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
17 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$0.00 |
| 1126F |
|
13 |
13 |
$0.00 |
| 87340 |
|
23 |
20 |
$0.00 |
| 99241 |
|
29 |
21 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
25 |
21 |
$0.00 |
| 90656 |
|
41 |
40 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
17 |
14 |
$0.00 |