| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
765 |
606 |
$60.88 |
| 99442 |
|
297 |
274 |
$0.00 |
| 99173 |
|
255 |
185 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
181 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
306 |
296 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
556 |
554 |
$0.00 |
| 98960 |
|
124 |
69 |
$0.00 |
| 90670 |
|
29 |
29 |
$0.00 |
| D1120 |
Prophylaxis - child |
271 |
186 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
269 |
154 |
$0.00 |
| 80061 |
Lipid panel |
87 |
87 |
$0.00 |
| 70310 |
|
30 |
29 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
25 |
$0.00 |
| 90461 |
|
185 |
185 |
$0.00 |
| D0350 |
|
258 |
175 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
151 |
97 |
$0.00 |
| 90633 |
|
15 |
15 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
22 |
13 |
$0.00 |
| 1033F |
|
12 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
46 |
42 |
$0.00 |
| 83655 |
|
14 |
14 |
$0.00 |
| D1310 |
|
123 |
69 |
$0.00 |
| 99441 |
|
105 |
100 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
985 |
965 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
226 |
183 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
270 |
268 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
221 |
154 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
220 |
219 |
$0.00 |
| 92551 |
|
184 |
132 |
$0.00 |
| 85027 |
|
415 |
415 |
$0.00 |
| D1330 |
|
271 |
186 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
215 |
196 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,285 |
989 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
125 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| 4450F |
|
243 |
241 |
$0.00 |
| 70300 |
|
146 |
144 |
$0.00 |
| 90686 |
|
89 |
89 |
$0.00 |
| 99443 |
|
38 |
38 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
31 |
31 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
27 |
27 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
33 |
33 |
$0.00 |
| 90656 |
|
13 |
13 |
$0.00 |
| 82728 |
|
15 |
15 |
$0.00 |
| 99243 |
|
13 |
12 |
$0.00 |
| 1000F |
|
12 |
12 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12 |
12 |
$0.00 |