| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
551 |
390 |
$42.78 |
| 36415 |
Collection of venous blood by venipuncture |
472 |
455 |
$0.00 |
| 70300 |
|
161 |
160 |
$0.00 |
| D1330 |
|
411 |
299 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
530 |
457 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
265 |
220 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
222 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,174 |
853 |
$0.00 |
| 92551 |
|
378 |
282 |
$0.00 |
| 85027 |
|
166 |
165 |
$0.00 |
| 4450F |
|
76 |
75 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
338 |
248 |
$0.00 |
| 99443 |
|
27 |
26 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
35 |
35 |
$0.00 |
| 90686 |
|
13 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
25 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
36 |
35 |
$0.00 |
| D1310 |
|
232 |
155 |
$0.00 |
| 85018 |
|
12 |
12 |
$0.00 |
| 90656 |
|
12 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
40 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
29 |
26 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
14 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$0.00 |
| 99173 |
|
449 |
330 |
$0.00 |
| D0350 |
|
401 |
297 |
$0.00 |
| D1120 |
Prophylaxis - child |
409 |
298 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
382 |
276 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
134 |
70 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
308 |
307 |
$0.00 |
| 99442 |
|
51 |
49 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
59 |
53 |
$0.00 |
| 98960 |
|
176 |
113 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
59 |
56 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
148 |
138 |
$0.00 |
| 70310 |
|
42 |
42 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
45 |
26 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| 85014 |
|
12 |
12 |
$0.00 |
| 80061 |
Lipid panel |
39 |
39 |
$0.00 |