| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
13,822 |
9,257 |
$1.78M |
| D0999 |
Unspecified diagnostic procedure, by report |
183 |
168 |
$18K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
58 |
41 |
$64.00 |
| 3074F |
|
805 |
661 |
$25.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,695 |
5,258 |
$22.00 |
| 3078F |
|
659 |
551 |
$21.00 |
| 3079F |
|
142 |
108 |
$7.00 |
| 3044F |
|
582 |
398 |
$4.00 |
| 3075F |
|
41 |
29 |
$3.00 |
| 82962 |
|
392 |
230 |
$1.00 |
| 3080F |
|
93 |
67 |
$1.00 |
| 3077F |
|
58 |
38 |
$1.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,471 |
1,039 |
$1.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
484 |
423 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
411 |
341 |
$0.00 |
| 90686 |
|
58 |
44 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$0.00 |
| 90688 |
|
15 |
14 |
$0.00 |
| 99383 |
|
18 |
17 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
121 |
68 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
18 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
358 |
272 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
65 |
61 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
41 |
$0.00 |
| 99173 |
|
176 |
128 |
$0.00 |
| 90715 |
|
15 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
42 |
42 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$0.00 |
| 81002 |
|
71 |
50 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
18 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12 |
12 |
$0.00 |
| 0502F |
|
18 |
14 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$0.00 |