| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,663 |
3,681 |
$647K |
| H2020 |
Therapeutic behavioral services, per diem |
7,180 |
3,450 |
$578K |
| D0999 |
Unspecified diagnostic procedure, by report |
571 |
359 |
$48K |
| 80305 |
|
618 |
398 |
$0.00 |
| 1159F |
|
1,095 |
801 |
$0.00 |
| D1110 |
Prophylaxis - adult |
204 |
158 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
441 |
273 |
$0.00 |
| 81003 |
|
266 |
162 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
762 |
320 |
$0.00 |
| 1160F |
|
1,098 |
805 |
$0.00 |
| 3078F |
|
605 |
445 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
441 |
270 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
113 |
46 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
71 |
53 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
54 |
42 |
$0.00 |
| 3074F |
|
715 |
529 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,235 |
2,563 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
548 |
349 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,701 |
2,468 |
$0.00 |
| 3008F |
|
1,083 |
796 |
$0.00 |
| 3353F |
|
367 |
259 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,936 |
1,243 |
$0.00 |
| 3351F |
|
105 |
70 |
$0.00 |
| 3354F |
|
39 |
28 |
$0.00 |
| 1000F |
|
535 |
378 |
$0.00 |
| 1125F |
|
330 |
247 |
$0.00 |
| 3079F |
|
203 |
152 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
63 |
35 |
$0.00 |
| 90688 |
|
20 |
14 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
420 |
243 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
71 |
51 |
$0.00 |
| 3075F |
|
85 |
60 |
$0.00 |
| 3352F |
|
223 |
173 |
$0.00 |
| 3044F |
|
17 |
15 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
25 |
$0.00 |