| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,004 |
2,921 |
$505K |
| D0999 |
Unspecified diagnostic procedure, by report |
4,498 |
3,903 |
$472K |
| D1120 |
Prophylaxis - child |
760 |
747 |
$1K |
| D1206 |
Topical application of fluoride varnish |
750 |
737 |
$702.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
47 |
27 |
$121.25 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,088 |
882 |
$85.05 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
386 |
288 |
$42.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
485 |
$26.08 |
| D0220 |
Intraoral - periapical first radiographic image |
1,059 |
1,007 |
$11.20 |
| D0120 |
Periodic oral evaluation - established patient |
768 |
753 |
$0.00 |
| D0602 |
|
129 |
126 |
$0.00 |
| D0603 |
|
33 |
33 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
31 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
187 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
251 |
179 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$0.00 |
| D0601 |
|
120 |
119 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
338 |
330 |
$0.00 |
| D9110 |
|
106 |
102 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
116 |
$0.00 |
| D0270 |
|
112 |
110 |
$0.00 |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
29 |
25 |
$0.00 |
| 99173 |
|
46 |
44 |
$0.00 |