| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
19,280 |
16,481 |
$3.22M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,748 |
3,427 |
$144K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,519 |
2,104 |
$129K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,615 |
2,092 |
$126K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,099 |
1,738 |
$114K |
| D0999 |
Unspecified diagnostic procedure, by report |
648 |
470 |
$38K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12,860 |
4,188 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
379 |
370 |
$18K |
| 99383 |
|
344 |
253 |
$13K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
184 |
170 |
$12K |
| 99381 |
|
208 |
161 |
$9K |
| 99382 |
|
231 |
179 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
236 |
229 |
$9K |
| 90461 |
|
4,175 |
2,869 |
$6K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
256 |
240 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
170 |
131 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
55 |
55 |
$2K |
| D1120 |
Prophylaxis - child |
109 |
76 |
$1K |
| D1206 |
Topical application of fluoride varnish |
146 |
114 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
43 |
41 |
$463.92 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
46 |
44 |
$375.30 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$222.30 |
| D0603 |
|
160 |
137 |
$200.03 |
| 90710 |
|
725 |
638 |
$126.64 |
| 90633 |
|
754 |
644 |
$103.94 |
| 90670 |
|
1,914 |
1,598 |
$100.36 |
| D0274 |
Bitewings - four radiographic images |
27 |
16 |
$98.80 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
15 |
$79.20 |
| 90686 |
|
724 |
635 |
$41.84 |
| 90696 |
|
185 |
167 |
$39.42 |
| 90715 |
|
160 |
139 |
$32.26 |
| 90734 |
|
158 |
139 |
$13.14 |
| 90658 |
|
33 |
31 |
$9.56 |
| 36415 |
Collection of venous blood by venipuncture |
79 |
75 |
$5.25 |
| 90723 |
|
1,443 |
1,231 |
$0.00 |
| 90651 |
|
57 |
57 |
$0.00 |
| 87428 |
|
38 |
37 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
160 |
121 |
$0.00 |
| D1330 |
|
15 |
13 |
$0.00 |
| 90688 |
|
16 |
14 |
$0.00 |
| 90680 |
|
94 |
94 |
$0.00 |
| 90474 |
|
51 |
51 |
$0.00 |
| 90681 |
|
401 |
327 |
$0.00 |
| 90648 |
|
1,855 |
1,557 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
252 |
244 |
$0.00 |
| 90700 |
|
75 |
68 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
155 |
68 |
$0.00 |