| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,021 |
10,489 |
$2.01M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,660 |
4,147 |
$5K |
| 0011A |
|
24 |
24 |
$870.00 |
| 3074F |
|
1,987 |
1,808 |
$635.00 |
| 3079F |
|
737 |
677 |
$600.00 |
| 3078F |
|
1,443 |
1,330 |
$510.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
450 |
421 |
$180.89 |
| 99215 |
Prolong outpt/office vis |
117 |
106 |
$124.21 |
| 3077F |
|
65 |
61 |
$110.00 |
| 3080F |
|
47 |
43 |
$60.00 |
| 3075F |
|
69 |
67 |
$50.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
92 |
92 |
$17.37 |
| 3725F |
|
1,166 |
1,097 |
$10.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
37 |
37 |
$9.00 |
| 1160F |
|
3,866 |
3,467 |
$0.00 |
| 1159F |
|
2,806 |
2,486 |
$0.00 |
| 99173 |
|
66 |
66 |
$0.00 |
| D1110 |
Prophylaxis - adult |
126 |
124 |
$0.00 |
| D1120 |
Prophylaxis - child |
27 |
27 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
44 |
$0.00 |
| 99051 |
|
14 |
13 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
42 |
36 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| 92552 |
|
17 |
17 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$0.00 |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
16 |
16 |
$0.00 |
| 3008F |
|
3,653 |
3,329 |
$0.00 |
| 1036F |
|
1,650 |
1,487 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
47 |
$0.00 |
| 1034F |
|
385 |
323 |
$0.00 |
| D1330 |
|
193 |
191 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
74 |
74 |
$0.00 |
| 96127 |
|
147 |
137 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |
| 92551 |
|
44 |
44 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
144 |
142 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
17 |
$0.00 |