| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
19,858 |
17,854 |
$4.38M |
| D0999 |
Unspecified diagnostic procedure, by report |
7,373 |
6,835 |
$1.92M |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,910 |
5,806 |
$37K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,606 |
1,579 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,788 |
9,059 |
$8K |
| 0002A |
|
161 |
160 |
$4K |
| 0001A |
|
138 |
136 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
401 |
362 |
$2K |
| 0071A |
|
46 |
46 |
$1K |
| 0012A |
|
39 |
39 |
$1K |
| 0072A |
|
41 |
41 |
$1K |
| 90686 |
|
2,340 |
2,319 |
$1K |
| 0011A |
|
31 |
31 |
$980.00 |
| 90473 |
|
103 |
102 |
$906.63 |
| 36415 |
Collection of venous blood by venipuncture |
265 |
259 |
$317.90 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
14 |
14 |
$216.60 |
| 2001F |
|
3,015 |
2,782 |
$101.73 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
104 |
103 |
$76.08 |
| 90656 |
|
39 |
39 |
$71.16 |
| 90672 |
|
247 |
245 |
$53.91 |
| 90474 |
|
25 |
25 |
$36.24 |
| 90670 |
|
152 |
152 |
$21.27 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
193 |
166 |
$17.99 |
| 90674 |
|
50 |
50 |
$16.84 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
74 |
74 |
$0.00 |
| G8752 |
Most recent systolic blood pressure < 140 mmhg |
806 |
746 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,789 |
1,787 |
$0.00 |
| D1120 |
Prophylaxis - child |
62 |
62 |
$0.00 |
| 3078F |
|
2,409 |
2,257 |
$0.00 |
| 91300 |
|
406 |
377 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
273 |
265 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
905 |
904 |
$0.00 |
| 1159F |
|
1,553 |
1,402 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
402 |
379 |
$0.00 |
| D0330 |
Panoramic radiographic image |
159 |
159 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
125 |
121 |
$0.00 |
| 90734 |
|
33 |
33 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
228 |
228 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |
| 90687 |
|
145 |
138 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$0.00 |
| 90621 |
|
13 |
13 |
$0.00 |
| 90633 |
|
14 |
13 |
$0.00 |
| 3074F |
|
2,476 |
2,305 |
$0.00 |
| G8754 |
Most recent diastolic blood pressure < 90 mmhg |
891 |
818 |
$0.00 |
| 1111F |
|
494 |
466 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,340 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
214 |
214 |
$0.00 |
| 90723 |
|
49 |
49 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
732 |
730 |
$0.00 |
| 85018 |
|
211 |
208 |
$0.00 |
| 91301 |
|
98 |
95 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
684 |
681 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
55 |
$0.00 |
| 91305 |
|
48 |
47 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
154 |
152 |
$0.00 |
| 90660 |
|
16 |
16 |
$0.00 |
| 90688 |
|
49 |
43 |
$0.00 |
| 90697 |
|
13 |
13 |
$0.00 |
| 90651 |
|
36 |
33 |
$0.00 |
| D9920 |
|
15 |
14 |
$0.00 |
| 99429 |
|
43 |
43 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
37 |
$0.00 |
| 91307 |
|
131 |
126 |
$0.00 |
| 90680 |
|
13 |
13 |
$0.00 |
| 90647 |
|
13 |
13 |
$0.00 |