| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,034 |
13,126 |
$2.31M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,111 |
3,569 |
$610K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,593 |
1,397 |
$431K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,595 |
2,357 |
$419K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,023 |
728 |
$129K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
388 |
305 |
$46K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
292 |
245 |
$36K |
| D0431 |
|
1,374 |
159 |
$29K |
| 97803 |
|
153 |
146 |
$28K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
168 |
138 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
946 |
148 |
$17K |
| 97802 |
|
78 |
78 |
$15K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
132 |
81 |
$15K |
| D1110 |
Prophylaxis - adult |
410 |
106 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
118 |
103 |
$12K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
89 |
84 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
66 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
444 |
78 |
$6K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
42 |
39 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
43 |
$6K |
| 99442 |
|
34 |
34 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$3K |
| D0180 |
|
54 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
13 |
$193.25 |