| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,014 |
2,101 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
1,379 |
913 |
$57K |
| D1110 |
Prophylaxis - adult |
960 |
666 |
$55K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
450 |
377 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
663 |
291 |
$22K |
| D1120 |
Prophylaxis - child |
429 |
288 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
284 |
155 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
99 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
139 |
$9K |
| D1206 |
Topical application of fluoride varnish |
136 |
135 |
$4K |
| D0274 |
Bitewings - four radiographic images |
134 |
104 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
38 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
38 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
99 |
$1K |
| D0330 |
Panoramic radiographic image |
21 |
13 |
$1K |
| 96127 |
|
39 |
12 |
$728.13 |
| 36415 |
Collection of venous blood by venipuncture |
89 |
85 |
$267.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$238.00 |
| D9995 |
|
52 |
52 |
$0.00 |
| D1999 |
|
41 |
40 |
$0.00 |