| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,266 |
12,811 |
$1.20M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,936 |
7,557 |
$325K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,288 |
3,383 |
$216K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,231 |
1,414 |
$44K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
500 |
305 |
$14K |
| Q3014 |
Telehealth originating site facility fee |
1,155 |
614 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
434 |
231 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
716 |
377 |
$9K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
234 |
127 |
$7K |
| 80305 |
|
938 |
367 |
$5K |
| 92551 |
|
1,225 |
662 |
$4K |
| 81025 |
|
861 |
411 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
78 |
40 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
241 |
133 |
$2K |
| 90686 |
|
1,144 |
964 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
253 |
154 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
326 |
233 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
56 |
29 |
$1K |
| 99173 |
|
822 |
477 |
$1K |
| 90688 |
|
308 |
247 |
$887.00 |
| 81002 |
|
727 |
317 |
$821.41 |
| 99382 |
|
24 |
13 |
$795.19 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
21 |
12 |
$616.80 |
| D1120 |
Prophylaxis - child |
155 |
125 |
$500.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
185 |
151 |
$420.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
59 |
$289.85 |
| 90685 |
|
90 |
82 |
$114.50 |
| 90633 |
|
113 |
90 |
$98.75 |
| 90707 |
|
60 |
55 |
$73.00 |
| 90651 |
|
84 |
71 |
$41.50 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$34.16 |
| 90716 |
|
88 |
72 |
$30.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
18 |
18 |
$29.00 |
| 90670 |
|
73 |
69 |
$25.75 |
| 90698 |
|
42 |
39 |
$25.75 |
| 90696 |
|
20 |
16 |
$10.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$5.00 |
| 4004F |
|
3,020 |
2,714 |
$0.00 |
| 3078F |
|
7,933 |
7,062 |
$0.00 |
| 1159F |
|
1,147 |
1,021 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
833 |
755 |
$0.00 |
| 1160F |
|
1,146 |
1,020 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
119 |
108 |
$0.00 |
| 90461 |
|
159 |
59 |
$0.00 |
| 90734 |
|
29 |
24 |
$0.00 |
| 3074F |
|
8,470 |
7,503 |
$0.00 |
| 1036F |
|
5,045 |
4,344 |
$0.00 |
| 3075F |
|
265 |
243 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
299 |
276 |
$0.00 |
| 3079F |
|
747 |
673 |
$0.00 |
| 3008F |
|
843 |
768 |
$0.00 |
| 90744 |
|
15 |
12 |
$0.00 |