| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,829 |
6,150 |
$1.02M |
| D0999 |
Unspecified diagnostic procedure, by report |
856 |
759 |
$100K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,401 |
3,544 |
$282.02 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,572 |
1,228 |
$72.97 |
| 90686 |
|
41 |
40 |
$41.06 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
245 |
230 |
$24.25 |
| D0180 |
|
28 |
28 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
53 |
52 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
103 |
103 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
40 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
174 |
$0.00 |
| 3008F |
|
35 |
35 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$0.00 |