| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
27,357 |
21,730 |
$3.59M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,616 |
3,198 |
$898.80 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,066 |
2,712 |
$358.08 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
612 |
549 |
$153.04 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21 |
21 |
$119.35 |
| 81025 |
|
144 |
133 |
$4.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
634 |
618 |
$0.00 |
| D1310 |
|
81 |
81 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
2,703 |
2,438 |
$0.00 |
| 99443 |
|
80 |
70 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
396 |
394 |
$0.00 |
| 85018 |
|
30 |
29 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
566 |
560 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
13 |
$0.00 |
| D1330 |
|
191 |
191 |
$0.00 |
| 98967 |
|
310 |
300 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
33 |
32 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
77 |
68 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
618 |
609 |
$0.00 |
| 81000 |
|
171 |
146 |
$0.00 |
| 99441 |
|
94 |
89 |
$0.00 |
| 3074F |
|
13 |
13 |
$0.00 |
| 99385 |
|
18 |
12 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
299 |
258 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
476 |
469 |
$0.00 |
| 99173 |
|
132 |
132 |
$0.00 |
| D1110 |
Prophylaxis - adult |
452 |
452 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,075 |
1,052 |
$0.00 |
| D1120 |
Prophylaxis - child |
39 |
39 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
43 |
42 |
$0.00 |
| D9110 |
|
419 |
412 |
$0.00 |
| 92552 |
|
83 |
83 |
$0.00 |
| 98966 |
|
111 |
110 |
$0.00 |
| 99442 |
|
382 |
349 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
44 |
$0.00 |
| 80061 |
Lipid panel |
42 |
41 |
$0.00 |
| 3078F |
|
13 |
13 |
$0.00 |
| 99080 |
|
25 |
25 |
$0.00 |
| 90658 |
|
37 |
37 |
$0.00 |
| 98968 |
|
13 |
13 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$0.00 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$0.00 |