| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96156 |
|
1,185 |
1,185 |
$74K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,057 |
3,700 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
985 |
983 |
$62K |
| 99385 |
|
326 |
326 |
$42K |
| 99383 |
|
287 |
287 |
$36K |
| 92552 |
|
3,148 |
3,131 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,180 |
2,881 |
$29K |
| D0330 |
Panoramic radiographic image |
973 |
972 |
$29K |
| D1110 |
Prophylaxis - adult |
233 |
233 |
$20K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
233 |
233 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
181 |
$18K |
| D1120 |
Prophylaxis - child |
392 |
392 |
$17K |
| 99384 |
|
107 |
107 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
116 |
$13K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
103 |
103 |
$10K |
| 99000 |
|
4,585 |
4,327 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
313 |
296 |
$6K |
| D1206 |
Topical application of fluoride varnish |
380 |
380 |
$6K |
| 99205 |
Prolong outpt/office vis |
63 |
59 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
342 |
$4K |
| 90632 |
|
141 |
114 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
231 |
$3K |
| 99382 |
|
24 |
24 |
$3K |
| 96150 |
|
732 |
728 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
109 |
107 |
$2K |
| 90716 |
|
226 |
226 |
$1K |
| 90633 |
|
262 |
260 |
$1K |
| 90713 |
|
267 |
265 |
$1K |
| 90744 |
|
264 |
262 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
331 |
313 |
$1K |
| 86703 |
|
443 |
439 |
$994.60 |
| 99215 |
Prolong outpt/office vis |
140 |
138 |
$904.64 |
| 87590 |
|
423 |
418 |
$852.16 |
| 90707 |
|
48 |
48 |
$809.22 |
| 81002 |
|
1,587 |
1,553 |
$766.97 |
| 86580 |
|
495 |
478 |
$624.88 |
| 80061 |
Lipid panel |
369 |
366 |
$565.62 |
| 90649 |
|
84 |
84 |
$556.13 |
| 85018 |
|
468 |
449 |
$329.59 |
| 90674 |
|
74 |
73 |
$282.06 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
279 |
277 |
$251.40 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$231.00 |
| 90715 |
|
14 |
12 |
$226.96 |
| 94760 |
|
2,557 |
2,338 |
$208.72 |
| 90656 |
|
48 |
48 |
$200.86 |
| 90734 |
|
43 |
43 |
$198.00 |
| 90700 |
|
40 |
40 |
$171.00 |
| 90714 |
|
31 |
31 |
$99.00 |
| 99173 |
|
1,383 |
1,377 |
$70.68 |
| 90657 |
|
12 |
12 |
$27.00 |
| 90658 |
|
14 |
14 |
$20.00 |
| 81000 |
|
12 |
12 |
$16.83 |
| 81025 |
|
14 |
12 |
$8.52 |
| 36415 |
Collection of venous blood by venipuncture |
1,021 |
994 |
$8.25 |
| 96160 |
|
264 |
263 |
$6.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
64 |
63 |
$4.46 |
| 82948 |
|
333 |
308 |
$2.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
27 |
$0.00 |
| 90655 |
|
40 |
40 |
$0.00 |