| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
42,881 |
35,681 |
$6.09M |
| 00003 |
Internal/system code - not a standard HCPCS code |
8,872 |
5,911 |
$1.95M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,125 |
11,963 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
323 |
224 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
115 |
$1K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
149 |
87 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
109 |
$1K |
| 90834 |
Psychotherapy, 45 minutes with patient |
23 |
12 |
$556.05 |
| 59425 |
|
22 |
13 |
$193.52 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$118.00 |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
58 |
$105.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$61.20 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,428 |
4,151 |
$46.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
13 |
$37.80 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
71 |
70 |
$36.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
976 |
936 |
$30.00 |
| 81002 |
|
1,030 |
709 |
$3.44 |
| 3078F |
|
1,505 |
1,210 |
$0.01 |
| 3074F |
|
1,618 |
1,280 |
$0.00 |
| Z1034 |
|
4,294 |
2,695 |
$0.00 |
| D1330 |
|
257 |
231 |
$0.00 |
| Z1032 |
|
52 |
51 |
$0.00 |
| 99441 |
|
15 |
13 |
$0.00 |
| 3079F |
|
13 |
12 |
$0.00 |
| 1159F |
|
2,705 |
1,992 |
$0.00 |
| 1160F |
|
2,618 |
1,945 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
13 |
13 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
19 |
15 |
$0.00 |