| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,423 |
3,065 |
$202K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,301 |
2,040 |
$194K |
| D0140 |
Limited oral evaluation - problem focused |
977 |
796 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
54 |
$24K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
235 |
215 |
$18K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
314 |
304 |
$15K |
| 36415 |
Collection of venous blood by venipuncture |
1,462 |
1,344 |
$9K |
| 99385 |
|
85 |
81 |
$7K |
| D0330 |
Panoramic radiographic image |
114 |
97 |
$7K |
| D1320 |
|
617 |
508 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
129 |
124 |
$5K |
| 90674 |
|
83 |
72 |
$2K |
| D0274 |
Bitewings - four radiographic images |
63 |
52 |
$2K |
| 86803 |
|
98 |
90 |
$1K |
| 87428 |
|
43 |
41 |
$1K |
| 86703 |
|
132 |
120 |
$1K |
| 99386 |
|
12 |
12 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
245 |
210 |
$910.05 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
48 |
46 |
$555.10 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
60 |
59 |
$520.50 |
| 81003 |
|
12 |
12 |
$10.55 |
| D1310 |
|
451 |
367 |
$0.00 |
| D1330 |
|
451 |
367 |
$0.00 |
| D0191 |
|
16 |
16 |
$0.00 |