| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,618 |
8,503 |
$1.81M |
| D0999 |
Unspecified diagnostic procedure, by report |
7,014 |
4,539 |
$602K |
| 0012A |
|
61 |
58 |
$3K |
| 0011A |
|
64 |
59 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
672 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,011 |
1,690 |
$894.16 |
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
864 |
$424.12 |
| D4355 |
|
30 |
15 |
$287.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,862 |
1,444 |
$263.13 |
| D1110 |
Prophylaxis - adult |
307 |
254 |
$246.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,269 |
3,295 |
$203.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,779 |
1,536 |
$147.62 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,254 |
870 |
$143.26 |
| D0120 |
Periodic oral evaluation - established patient |
261 |
229 |
$84.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
71 |
61 |
$45.82 |
| D1120 |
Prophylaxis - child |
687 |
587 |
$41.00 |
| D0274 |
Bitewings - four radiographic images |
525 |
465 |
$36.84 |
| 90832 |
Psychotherapy, 30 minutes with patient |
212 |
104 |
$29.48 |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
150 |
$26.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
79 |
65 |
$10.00 |
| 99442 |
|
26 |
12 |
$2.00 |
| 99441 |
|
35 |
24 |
$2.00 |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
265 |
192 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
76 |
63 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
129 |
121 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
104 |
96 |
$0.00 |
| D0270 |
|
19 |
14 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
21 |
16 |
$0.00 |
| D4341 |
|
17 |
12 |
$0.00 |
| 99385 |
|
225 |
158 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
230 |
185 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
763 |
583 |
$0.00 |
| D0603 |
|
575 |
466 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
37 |
$0.00 |
| D1351 |
Sealant - per tooth |
33 |
15 |
$0.00 |
| D0601 |
|
93 |
67 |
$0.00 |
| 99386 |
|
78 |
71 |
$0.00 |
| D0602 |
|
59 |
45 |
$0.00 |
| 99383 |
|
13 |
13 |
$0.00 |