| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
11,394 |
8,977 |
$2.09M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
21,546 |
17,282 |
$432K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,963 |
6,580 |
$56K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,505 |
2,055 |
$54K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,269 |
2,104 |
$51K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,177 |
3,955 |
$46K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,535 |
4,262 |
$39K |
| 90697 |
|
1,122 |
1,018 |
$28K |
| 90671 |
|
1,058 |
960 |
$28K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
866 |
794 |
$25K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
644 |
541 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
689 |
620 |
$11K |
| 92551 |
|
2,003 |
1,858 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
294 |
267 |
$8K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
368 |
347 |
$7K |
| 99173 |
|
2,021 |
1,876 |
$4K |
| 90474 |
|
854 |
803 |
$4K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
397 |
379 |
$4K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
2,482 |
2,292 |
$3K |
| 81002 |
|
7,150 |
4,740 |
$3K |
| 0012A |
|
80 |
80 |
$3K |
| 90681 |
|
1,092 |
1,030 |
$2K |
| 81025 |
|
991 |
812 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
247 |
226 |
$1K |
| 90688 |
|
1,663 |
1,484 |
$1K |
| 90716 |
|
69 |
61 |
$1K |
| D0190 |
|
1,405 |
1,195 |
$1K |
| 90698 |
|
768 |
733 |
$1K |
| 0011A |
|
31 |
31 |
$1K |
| 88142 |
|
30 |
30 |
$806.05 |
| 90686 |
|
178 |
167 |
$798.57 |
| 90633 |
|
270 |
235 |
$686.59 |
| 99401 |
|
655 |
613 |
$641.13 |
| 90707 |
|
63 |
55 |
$527.46 |
| D1110 |
Prophylaxis - adult |
32 |
31 |
$493.00 |
| 97802 |
|
177 |
172 |
$484.68 |
| 0002A |
|
16 |
13 |
$480.00 |
| 0001A |
|
12 |
12 |
$440.00 |
| D1120 |
Prophylaxis - child |
54 |
52 |
$430.00 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
40 |
$420.00 |
| 90670 |
|
1,114 |
1,042 |
$405.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$364.00 |
| 92081 |
|
27 |
27 |
$357.09 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
16 |
12 |
$324.44 |
| D0220 |
Intraoral - periapical first radiographic image |
234 |
213 |
$315.00 |
| 90658 |
|
25 |
25 |
$200.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
19 |
18 |
$189.26 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$180.00 |
| 82962 |
|
297 |
239 |
$172.46 |
| 93000 |
|
12 |
12 |
$126.54 |
| 97803 |
|
293 |
286 |
$113.05 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
36 |
36 |
$89.40 |
| 87590 |
|
37 |
27 |
$85.00 |
| 99381 |
|
1,009 |
1,004 |
$66.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
160 |
160 |
$42.58 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
12 |
$35.75 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
15 |
12 |
$6.60 |
| 87490 |
|
38 |
37 |
$4.00 |
| 90744 |
|
553 |
550 |
$0.00 |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
136 |
93 |
$0.00 |
| 99000 |
|
111 |
91 |
$0.00 |
| D1330 |
|
98 |
94 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |
| 86580 |
|
12 |
12 |
$0.00 |
| 90680 |
|
19 |
19 |
$0.00 |