| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0004A |
|
416 |
412 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,014 |
7,493 |
$12K |
| D1999 |
|
569 |
507 |
$8K |
| 0002A |
|
298 |
291 |
$8K |
| 0001A |
|
380 |
367 |
$8K |
| D1110 |
Prophylaxis - adult |
307 |
282 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
918 |
721 |
$4K |
| 0071A |
|
79 |
78 |
$3K |
| 0072A |
|
72 |
71 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
193 |
178 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
118 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,260 |
673 |
$2K |
| D0330 |
Panoramic radiographic image |
58 |
54 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
235 |
228 |
$1K |
| 0003A |
|
21 |
21 |
$800.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
35 |
$430.07 |
| 92015 |
Determination of refractive state |
75 |
75 |
$142.40 |
| 99442 |
|
66 |
51 |
$53.49 |
| 99441 |
|
230 |
218 |
$32.47 |
| 99401 |
|
800 |
464 |
$0.00 |
| 1160F |
|
5,897 |
4,180 |
$0.00 |
| 1159F |
|
5,945 |
4,201 |
$0.00 |
| 4035F |
|
2,776 |
2,331 |
$0.00 |
| 99173 |
|
809 |
494 |
$0.00 |
| 96160 |
|
1,345 |
778 |
$0.00 |
| 3078F |
|
1,066 |
881 |
$0.00 |
| 0521F |
|
470 |
357 |
$0.00 |
| 91300 |
|
1,186 |
1,034 |
$0.00 |
| G0451 |
Development testing, with interpretation and report, per standardized instrument form |
44 |
43 |
$0.00 |
| 99408 |
|
129 |
94 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
38 |
13 |
$0.00 |
| 3077F |
|
54 |
53 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
45 |
29 |
$0.00 |
| S0613 |
Annual gynecological examination; clinical breast examination without pelvic evaluation |
26 |
26 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
34 |
14 |
$0.00 |
| 90734 |
|
12 |
12 |
$0.00 |
| 3008F |
|
4,300 |
3,008 |
$0.00 |
| 1126F |
|
3,528 |
2,764 |
$0.00 |
| 1170F |
|
689 |
669 |
$0.00 |
| 2010F |
|
2,608 |
2,012 |
$0.00 |
| 1125F |
|
1,074 |
587 |
$0.00 |
| 2001F |
|
4,909 |
3,518 |
$0.00 |
| 3074F |
|
1,652 |
1,398 |
$0.00 |
| 3075F |
|
89 |
83 |
$0.00 |
| 2000F |
|
2,715 |
2,094 |
$0.00 |
| 3079F |
|
488 |
392 |
$0.00 |
| 96112 |
|
143 |
129 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
388 |
234 |
$0.00 |
| 91307 |
|
152 |
147 |
$0.00 |
| 90686 |
|
184 |
167 |
$0.00 |
| 90651 |
|
52 |
52 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$0.00 |