| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,931 |
2,874 |
$775K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,365 |
1,124 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
84 |
69 |
$1K |
| 90461 |
|
180 |
161 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
604 |
530 |
$1K |
| 86328 |
|
38 |
29 |
$124.62 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
135 |
120 |
$0.00 |
| D1330 |
|
264 |
234 |
$0.00 |
| 90686 |
|
133 |
122 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
39 |
38 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
242 |
239 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
27 |
$0.00 |
| 92552 |
|
55 |
54 |
$0.00 |
| D1120 |
Prophylaxis - child |
162 |
161 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
45 |
45 |
$0.00 |
| D0190 |
|
274 |
257 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
18 |
13 |
$0.00 |
| 99173 |
|
57 |
57 |
$0.00 |
| 99442 |
|
80 |
77 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$0.00 |
| 90670 |
|
40 |
25 |
$0.00 |
| 99177 |
|
12 |
12 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$0.00 |