| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,872 |
1,679 |
$72K |
| T1015 |
Clinic visit/encounter, all-inclusive |
186 |
129 |
$36K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
62 |
49 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
56 |
52 |
$1K |
| D1110 |
Prophylaxis - adult |
62 |
62 |
$717.25 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
30 |
27 |
$678.32 |
| 0011A |
|
41 |
41 |
$557.27 |
| 0012A |
|
43 |
43 |
$542.43 |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
102 |
$217.50 |
| 99401 |
|
14 |
12 |
$205.97 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
15 |
$187.81 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
16 |
$37.75 |
| 36415 |
Collection of venous blood by venipuncture |
16 |
16 |
$29.10 |
| 90686 |
|
28 |
28 |
$1.00 |
| 3725F |
|
59 |
50 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
77 |
67 |
$0.00 |
| 1036F |
|
35 |
30 |
$0.00 |
| D1330 |
|
38 |
38 |
$0.00 |
| 91301 |
|
103 |
100 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$0.00 |
| 99000 |
|
15 |
12 |
$0.00 |