| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,722 |
1,655 |
$251K |
| D7140 |
Extraction, erupted tooth or exposed root |
473 |
146 |
$13K |
| D0330 |
Panoramic radiographic image |
406 |
229 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
204 |
$7K |
| D1110 |
Prophylaxis - adult |
231 |
129 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
392 |
215 |
$4K |
| D0272 |
Bitewings - two radiographic images |
92 |
54 |
$826.82 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
303 |
181 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
376 |
256 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
1,234 |
670 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
25 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27 |
16 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
259 |
126 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$0.00 |